Since 9 September 2024, all deaths in any health setting that are not investigated by a coroner will be reviewed by NHS medical examiners. The changes form part of the Department of Health and Social Care’s Death Certification Reforms.

The Death Certification Reforms introduced a new medical certificate of cause of death (MCCD). Medical practitioners are now able to complete an MCCD if they attended the deceased in their lifetime. This represents a simplification of previous rules when cases had to be referred to a coroner if the medical practitioner had not seen the patient within the 28 days prior to death or had not seen in person the patient after death.

What this means for healthcare providers

As all deaths in England and Wales not investigated by a coroner must be independently reviewed by a medical examiner, all healthcare providers including GP practices and independent healthcare providers employing medical practitioners who complete MCCDs must work with an NHS medical examiner office.

• Medical examiners can offer support with complex cases, administrative elements of notifications to coroners where agreed, and reduced administration.
• Implementing medical examiners does not introduce any new requirement to view the body.
• There is no need for a verbal discussion between GPs or doctors completing MCCDs and the medical examiner. In most cases medical examiners only need access to relevant parts of the record (or a summary) and last entry.
• The National Medical Examiner encourages medical examiners to adopt a constructive and developmental approach, respectful of the professional status of clinical colleagues.
• Find out more about the role of medical examiners.

The following podcasts are available on the NHS England Soundcloud channel:

• Changes introduced by the Death Certification Reforms.
• GPs and medical examiners working together – explains how partnership working between GPs and medical examiners improves the experience of bereaved people.

Background to the medical examiner system

Acute trusts in England and local health boards in Wales were asked to set up medical examiner offices to initially focus on the certification of all deaths that occur in their own organisation on a non-statutory basis. In June 2021, NHS England sent a system wide letter setting out what local health systems needed to do to extend the role of these offices to include all non-coronial deaths, wherever they occur.

In December 2023, the Department of Health and Social Care (DHSC) published draft regulations, and in April 2024 the government announced the Death Certification Reforms would come into force on 9 September 2024. The new government confirmed the start date in July 2024.