The Department of Health and Social Care (DHSC) is leading implementation of the death certification reforms. The medical examiner (ME) system has been rolled out over the last few years, with over 800,000 deaths in England and Wales having been reviewed in the non-statutory phase. The system will move to a statutory footing from 9 September 2024, following which it will not be possible for a death to be registered in England or Wales without review by either a medical examiner or a Coroner, and many deaths will be reviewed by both.

Almost all hospital deaths have been reviewed by MEs for several years, with increasing numbers of community deaths more recently. From January to March this year, medical examiner offices in England reported providing independent scrutiny of 44% of deaths in the community, and that figure is likely to be higher by now. All ME offices are preparing to review 100% of community deaths by September.

Several changes are being made to the Medical Certificate of Cause of Death (MCCD) from September. These changes include:

• the requirement for a medical examiner to sign the certificate in addition to the attending doctor
• the addition of a line 1d to the formulation of the cause of death
• the opportunity to record the ethnicity of the deceased if known
• a question about whether it is a maternal death
• a section for recording the presence of a pacemaker or other medical implant.

DHSC will distribute paper copies of the new MCCD in time for use from 9 September and will provide guidance. DHSC have also commissioned the NHS Business Services Authority to develop a digital MCCD, but this will not be available until later this year.

In the current system, the attending practitioner who writes the MCCD must have attended the deceased during their last illness and have seen them either in the last 28 days or after death. In the new system, any doctor who attended the deceased at any time during their lifetime can complete the MCCD if they know the cause of death and Coroner referral is not required. This increases the pool of doctors available to complete certificates, which should reduce delays for bereaved families.

In the current system, registrars review the cause of death and can raise any concerns with the Coroner. Concerns might include an incorrectly formulated cause of death, an unacceptable cause of death, or an unnatural cause of death, such as including a medical or surgical procedure or accident.

In the new system, the registrar will copy the cause of death on the MCCD onto the death certificate that is given to the family. They will no longer refer cases to the Coroner. If new information becomes available to the registrar, or they have any queries about the certified cause of death, they will contact the ME for clarification.

In exceptional circumstances, where the cause of death is known but there is no doctor available within a reasonable time to write the MCCD and the Coroner has reviewed the case, decides not to investigate further and refers the case to the ME, the ME can complete an ME MCCD. This will reduce the number of uncertified deaths.

All training materials, including e-learning modules and scenarios for the face-to-face training day, are being updated in line with the reforms. New MEs attending training from September will complete the new material. Existing MEs will not have to redo all the training but should complete the four e-learning modules that cover changes to the relevant legislation.

The College is also developing a CPD programme for ME and ME Officer (MEO) members, with webinars on current topics.

The confirmatory medical certificate (Cremation Form 5 this is fine but legally it’s called Form Cremation 5) was removed during the pandemic and not reinstated. The medical certificate (Cremation Form 4 legally Form Cremation 4), currently completed by the attending practitioner, will be removed from September, with ME scrutiny replacing the need for a crematorium medical referee (CMR) to review the medical circumstances of a death. CMRs will continue to review all applications for cremations for a transitional period of at least 6 months from September and may be phased out after that.

I’d like to take this opportunity to thank everyone involved in the development of the ME role. The statutory ME system would not have been possible without the work of the College’s Medical Examiners Committee and I’d like to acknowledge the work of past chairs Professor Peter Furness and Dr Alan Fletcher, and current chair Dr Golda Shelley-Fraser for their leadership and perseverance, and Daisy Shale, the College’s Lead MEO, for her support of ME and MEO training.

I am also grateful for the dedication and generosity of the training facilitators, who have given up their own time to train over 3,000 MEs and MEOs.

Return to the July 2024 Bulletin

Read next

Member only content

Get involved in National Pathology Week 2024

13 June 2024

Inaugural Industry Leaders’ Forum held at the College

19 June 2024

Member only content

Pathology Portal wins high commendation award at HSJ awards

07 June 2024