The national medical examiner system

A new statutory medical examiner system is being rolled out across England and Wales to provide independent scrutiny of deaths, and to give bereaved people a voice. From 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, which form part of the Department of Health’s Death Certification Reforms, were announced by the government on 15 April 2024, and come into force on 9 September 2024. As part of the changes, there will be a new medical certificate of cause of death (MCCD). From 9 September 2024, medical practitioners will be able to complete an MCCD if they attended the deceased in their lifetime. This represents a simplification of the current rules, which before 9 September require referral of the case to a coroner for review 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.

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. Each medical examiner office is leading work to establish arrangements with local health and care providers in their area, supported by regional medical examiners where needed.

In December 2023, the Department of Health and Social Care published the draft regulations.

Medical examiners

Medical examiners are senior medical doctors who are contracted for a number of sessions a week to provide independent scrutiny of the causes of death, outside their usual clinical duties. They are trained in the legal and clinical elements of death certification processes.

The purpose of the medical examiner system is to:

  • 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 a better service for the bereaved and an opportunity for them to raise any concerns to a doctor not involved in the care of the deceased
  • improve the quality of death certification
  • improve the quality of mortality data.

We have also created a webpage providing specific information for colleagues working in primary care, and in other non-acute healthcare settings, such as mental health trusts and community trusts.

Medical examiner offices in England

Medical examiner offices in England are based at acute trusts (and a small number of specialist trusts). They are staffed by a team of medical examiners, supported by medical examiner officers.

The role of these offices is to examine deaths to:

  • agree the proposed cause of death and the overall accuracy of the medical certificate of cause of death (MCCD) with the doctor completing it
  • discuss the cause of death with bereaved people and establish if they have questions or any concerns with care before death
  • act as a medical advice resource for the local coroner
  • identify cases for further review under local mortality arrangements and contribute to other clinical governance processes.

National Medical Examiner’s good practice guidelines

To support medical examiners to ensure there is consistency in the implementation of medical examiner offices, we have produced good practice guidelines setting out how the National Medical Examiner expects medical examiner offices to operate during the current non-statutory phase of the programme. The document sets out good practice from the National Medical Examiner, and learning from pilot sites and early adopters.

Funding for medical examiners

For approximately 3,000 deaths, one whole time equivalent medical examiner (from a pool of varying specialities on a rota) and three whole time equivalent medical examiner officers will provide adequate cover and should be used as a guide to reasonable costs. The National Medical Examiner’s office agrees a funding envelope with each medical examiner office each year.

Regional support

Each NHS region has regional medical examiner and a regional medical examiner officer to support medical examiner offices. Regional medical examiners oversee the provision of services and provide an independent line of advice and accountability for medical examiners at trusts in their region.

The national medical examiner

In March 2019, Dr Alan Fletcher was appointed as National Medical Examiner for England and Wales.

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.

The national medical examiner’s team can be contacted by emailing:

National medical examiner updates

We issue regular updates providing useful information and news to support medical examiner offices.

National medical examiner reports

Each year the National Medical Examiner publishes 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.

Good Practice Series

The Good Practice Series is a topical collection of focused summary documents, designed to be easily read and digested by medical examiners and other busy frontline staff, with links to further reading, guidance and support. Good Practice papers are published by the Royal College of Pathologists.

Events and training

The lead college for medical examiners is the Royal College of Pathologists.

Medical examiner information and events: The Royal College of Pathologists provides information about medical examiners and hosts events including annual conferences.

Medical examiner training: Medical examiner training involves the completion of 26 core e-learning modules, followed by attendance at a face-to-face training day. More details can be found on the medical examiner training webpage.

Medical examiner officer training: Medical examiner training involves the completion of 26 core e-learning modules, followed by attendance at a face-to-face training day. More details can be found on the RCPath medical examiner officer training webpage.

The medical examiner officer training record and supporting documents are available.

National exemplar forms

Examplar forms can be found with the outcome of the Department of Health and Social Care’s (DHSC) Death Certification Reforms consultation. These forms were developed for use and evaluation by pilot areas working with the Department of Health and Social Care.

Appraisal and revalidation of medical examiners

The Royal College of Pathologists has published supporting information for appraisal and revalidation, including specialty specific information for medical examiners.

Death certification processes and cremation forms after the Coronavirus Act 2020 expires – information and guidance for medical practitioners

The Coronavirus Act 2020, which introduced easements to death certification processes and cremation forms, expired at midnight on 24 March 2022. Some changes were retained on a permanent basis through other measures, and other processes revert to previous practice.

The following provisions are from 24 March 2022 until the new regulations begin on 9 September 2024:

  • The period before death within which a doctor completing a Medical Certificate of Cause of Death (MCCD) must have seen a deceased patient will remain 28 days (prior to the coronavirus pandemic, the limit was 14 days).
  • It will still be acceptable for medical practitioners to send MCCDs to registrars electronically.
  • The government’s intention is that the form Cremation 5 will not be re-introduced after the Coronavirus Act expires.

The following emergency provisions are changing with the expiry of the Coronavirus Act on 24 March 2022:

  • The provision temporarily allowing any medical practitioner to complete the MCCD, introduced as a temporary measure by the Coronavirus Act, was discontinued on 24 March 2022.
  • Informants will have to register deaths in person, not remotely.

NHS England published Information for medical practitioners after the Coronavirus Act 2020 expires.