Today marks the start of the new statutory medical examiner system in England and Wales, which introduces changes to the death certification process and a new medical certificate of cause of death (MCCD).

It is now mandatory for all deaths, including those in the community, to be reviewed either by a medical examiner or through a coroner’s investigation.

How will the reforms affect doctors?

The main change will be around who can certify deaths and complete the new medical certificate of cause of death (MCCD).

Previously, the doctor signing the death certificate had to have attended the patient during their last illness, and deaths had to be referred to the coroner if the doctor had not seen the patient within 28 days prior to the death or after death.

Now, any doctor who attended the deceased during their lifetime can complete the MCCD.

These reforms aim to increase the number of doctors eligible to sign the MCCD and will avoid delays in certifying deaths, especially when staff are on leave or unavailable. The attending practitioner should complete the MCCD to the best of their knowledge and belief, as they do now.

Once the MCCD is completed, it must be discussed with a medical examiner, whose role is to scrutinise the death. Unlike before, it is now the medical examiner, not the attending practitioner, who will submit the MCCD to the registrar.

Medical examiners will also speak to the deceased's bereaved family, giving them an opportunity to ask questions or raise concerns. This can provide an opportunity for any concerns to be addressed at an early stage and hopefully resolved - potentially preventing complaints. The medical examiner will review the medical records and work with the attending practitioner to agree on the cause of death.

Will the MCCD change?

A new MCCD will replace the existing certificate, including the following changes. The goal is to make the death certification system more efficient and to enable the collection of mortality data both locally and nationally.

A new MCCD for deaths that occur after 28 days of life.
A separate MCCD when a child born alive dies within the first 28 days of life. As before, the certificate will contain the details of the attending practitioner who certified the death. The MCCD will also include the details of the medical examiner who carried out scrutiny of the death.
Space to include the patient’s ethnicity on the certificate. This information should come from the patient's self-declaration from their medical records and should not be a question asked of the deceased’s representative. If the information isn’t available in the patient’s records, the attending practitioner can put unknown.
Pregnancy status of the deceased is also included in the new MCCD. You are asked to record whether the deceased person was pregnant within the year prior to their death and if so, whether the pregnancy contributed to their death.
To bring the new MCCD into line with international standards, there will also be a new ‘1d’ line.
As the cremation form 4 will be obsolete, the presence of medical devices and implants will be recorded on the MCCD by the attending practitioner. This information will then be transferred to the certificate for burial or cremation which is completed by the registrar.

What happens if there is no attending practitioner to complete the MCCD?

A medical examiner certificate of cause of death is being introduced when there is no attending practitioner or when the attending practitioner isn’t available within a reasonable timeframe. These cases are expected to be rare.

However, if this situation occurs, the referring medical practitioner, not the medical examiner, should refer the death to the senior coroner. If the coroner decides the death does not need investigating, they will refer the case to a medical examiner to certify the death by completing a medical examiner MCCD.

Should I continue to refer deaths to the coroner?

Attending medical practitioners should continue to notify the coroner of deaths that meet the criteria outlined in Notification of Deaths Regulations 2019. These regulations will still apply once the new statutory medical examiner system begins, subject to minor amendments.

As they do now, the attending practitioner can inform the coroner directly in circumstances where the death meets the criteria, without needing to inform the medical examiner first. If the coroner decides an investigation is not required, the attending practitioner will complete the MCCD, and the medical examiner will scrutinise the death as usual.

When will we receive the new MCCD?

You must use the new MCCD from 12.01am on 9 September 2024. The Department of Health and Social Care will send new MCCDs to all organisations that currently use them. You will not be able to order the new certificates from your local registration services.

You can check whether your organisation is on the distribution list here, and if it isn't or any details are incorrect, email mccd@dhsc.gov.uk.

For more information about receiving the new MCCD, visit the government website.

We have more information and guidance on the new medical examiner system, including a dilemma on disclosing records under the new system.

Changes to medical examiner and death certificate processes

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