Medical examiners
Medical examiners are senior medical doctors who are contracted to provide independent scrutiny of the causes of deaths not investigated by coroners, outside their usual clinical duties. They are trained in the legal and clinical elements of death certification processes. They have statutory responsibilities which are set out in regulations. Medical examiners:
- provide greater safeguards for the public by ensuring independent scrutiny of all non-coronial deaths
- ensure the appropriate direction of deaths to the coroner
- provide bereaved people with an opportunity to ask questions and raise any concerns to someone not involved in the care of the deceased
- improve the quality of death certification
- improve the quality of mortality data
Standards guidance for England and Wales
Standards for medical examiners are set by the National Medical Examiner for England and Wales, who is appointed by the Secretary of State for Health and Social Care.
The National Medical Examiner’s guidance for England and Wales sets out these standards, and provides guidance for implementing them.
What medical examiners do
Medical examiners seek to answer 3 questions:
- What caused the death of the deceased?
- Does the coroner need to be notified of the death?
- Was the care before death appropriate?
Medical examiners answer these by providing independent scrutiny, with 3 elements:
- a proportionate review of relevant medical records
- interaction with the doctor completing the Medical Certificate of Cause of Death (MCCD)
- interaction with a bereaved person, providing an opportunity to ask questions and to raise concerns
Medical examiners’ conclusions can inform learning to improve care for future patients, and in a minority of cases are referred to established clinical governance processes for further review.
The national medical examiner
In March 2019, Dr Alan Fletcher was appointed as National Medical Examiner for England and Wales to provide professional and strategic leadership to medical examiners. The responsibilities are set out in the National Medical Examiner regulations.
The role of the national medical examiner is to provide professional and strategic leadership to regional and trust-based medical examiners. The role supports medical examiners in providing better safeguards for the public, patient safety monitoring and improvement, and informs the wider learning from deaths agenda.
- Contact the national medical examiner’s team by emailing: nme@nhs.net
Death certification reforms 2024
The government introduced changes to the death certification process to provide independent scrutiny of deaths in all cases, and give bereaved people a voice.
Since 9 September 2024, all deaths in any health setting that are not investigated by a coroner are reviewed by NHS medical examiners.
Find out more about:
- changes to the national medical examiner system
- death certification reforms and introduction of the statutory medical examiner system on Gov.uk
- the process after someone dies – a step by step guide for members of the public
National medical examiner reports
Each year the National Medical Examiner has published a report to show progress with implementing the medical examiner system, milestones achieved, examples of the impact medical examiners are having, and details of key activity during the period covered by each report.
National medical examiner annual reports 2020 to 2023
National medical examiner updates
The national medical examiner issues updates providing useful information and news to support medical examiner offices.