Welcome
As you’re aware, the death certification reforms will come into force on Monday 9 September 2024 meaning independent scrutiny by a medical examiner will become a statutory requirement prior to the registration of all non-coronial deaths in England and Wales from this date. The regulations were laid in both parliaments on Monday 15 April and announced by the Department of Health and Social Care and Welsh Government
We are getting close to finalising a revised draft of the Good practice guidelines, in readiness for the statutory system, this will be available soon.
Thank you for your patience leading up to this important milestone. This will ensure all bereaved people have a voice, supporting patient safety learning and improvement, including through accurate coroner referrals.
Dr Alan Fletcher, National Medical Examiner
What’s included in this update
Welcome
Receiving the new medical certificate of cause of death
Change to the attending practitioner criteria for medical certificate of cause of death
Good practice series – maternal deaths
Access to patient records
Communications
Quarterly reporting in England
Contact details
Further information
Receiving the new medical certificate of cause of death
The Department of Health and Social Care have published information on how healthcare providers will receive the new medical certificate of cause of death (MCCD). Bilingual versions will be distributed for use in Wales.
We are working with colleagues in communications to include this in NHS England bulletins.
Change to the attending practitioner criteria for medical certificate of cause of death
From 9 September 2024, if they can establish the cause of death, medical practitioners will be able to complete a medical certificate of cause of death (MCCD) if they attended the deceased in their lifetime.
As long as the medical practitioner attended the deceased, they can complete the MCCD and there will no longer be a requirement to have seen the patient within the 28 days before death, or to have seen the body after death. This change comes into force on 9 September 2024, and we have updated the national medical examiner webpage and GP information to make our information about it clearer.
The Department of Health and Social Care is leading the work around the new MCCD as it is a statutory form, including the distribution of paper copies, as well as an update to the MCCD guidance for doctors.
Good practice series – maternal deaths
Our latest guide in the Good practice series is available and focuses on maternal deaths.
We are currently working on several papers including deaths after delays in care and treatment and supporting bereaved people.
Access to patient records
There is updated information available about NHS e-Referral Service (e-RS), which now includes information about the legal basis for medical examiners to access patient records from 9 September 2024, in addition to the non-statutory system. This may be helpful for your information governance colleagues even if you are not using e-RS.
Until 9 September 2024, medical examiners have approval under Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 (‘section 251 support’) to process confidential information without consent (ref: 21/CAG/0032).
From 9 September 2024 the Access to Health Records Act 1990 will provide a statutory right for medical examiners in England and Wales to access health records – the Coroners and Justice Act 2009 (Commencement No. 22) Order 2024 (paragraph 3n) adds medical examiners to those who can access health records (schedule 21 paragraph 29).
Communications
There was a full house for the Royal College of Pathologists information event on 11 June. If you were unable to attend this session, ‘The death certification reforms legislation – update on implications for the medical examiner system’, please find a copy of the recording on the Royal College of Pathologists website.
NHS England’s Primary Care bulletin on 18 April included details of the regulations and the coming into force date of 9 September 2024. The Digest for Medical Directors on 29 April 2024 featured an item which noted that all NHS trusts with medical examiner offices will need to complete work in the next 3-4 months to comply with medical examiners’ terms of employment in the Medical Examiners (England) Regulations 2024.
In Wales, the Deputy Chief Medical Officer wrote to all Welsh stakeholders including primary care leads, organisations and NHS medical directors on 15 April 2024 with details of the regulations, the coming into force date and actions required before 9 September 2024.
Other materials are still available, including the podcast in which Dr Alan Fletcher and Dr Suzy Lishman, Senior Advisor on Medical Examiners at the Royal College of Pathologists, discuss the changes to death certification processes and what new requirements to be introduced with the statutory medical examiner system will mean for medical examiners, medical examiner officers and others involved in death certification.
Quarterly reporting in England
The National Medical Examiner’s team are reviewing the quarterly reporting requirements now it has been confirmed that the statutory system commences on 9 September 2024, and in light of funding being allocated through integrated care boards.
We plan to take the opportunity to reduce the total number of fields, and to reflect the new statutory process with a small number of new questions. The next quarterly submission (in early July 2024, for April-June 2024) will be the same as before, but this will be the final collection using the existing template. Submissions will be completed 1-19 July 2024. After this we will provide information to medical examiner offices about the updated reporting requirements for quarter 2 (July-September 2024). If you have queries, please contact reporting.nme@nhs.net.
Contact details
We encourage you to continue to raise queries with us and share your thoughts on the introduction of medical examiners, through the contacts list.
The page contains contact details for the National Medical Examiner’s Office, the Medical Examiner team in Wales, and regional medical examiner contacts in England.
Further information
Further information about the programme, including previous editions of this bulletin, can be found on the National medical examiner webpage.
NHS Wales Shared Services Partnership also has a web page for the medical examiner system in Wales.