Medical examiners to scrutinise deaths in the community

The medical examiner system is expanding out from acute trusts to include community settings, including GP practices.

GPs in England and Wales who are notified of a patient death will need to work closely with medical examiners to allow them to independently scrutinise deaths not referred to a coroner. This will include sharing records of deceased patients.

The introduction of the statutory medical examiner system will now start in April 2024 according to an update by the national medical examiner. Primary legislation has now been published, along with draft regulations.

The system will involve scrutiny by a medical examiner of all non-coronial deaths in England, with the process for community deaths already having started in Wales. The aim is to help improve the experience of bereaved people.

It is worth noting that according to the draft regulations, there will no longer be a requirement for the attending doctor to have seen the deceased 28 days before death. This will allow a wider pool of doctors to be able to complete the medical certificate of the cause of death (MCCD).

GP practices are being encouraged to use the time between now and April to work with medical examiners to help staff understand the process before the new regulations come into force.

Who are medical examiners?

Medical examiners are senior doctors from a range of specialties. They provide independent scrutiny of deaths that are not investigated by the coroner. Medical examiner offices have been set up and some are already working with GP practices locally.

The appointment of medical examiners has been a key component for the improvements to the death certification process in England and Wales. The need for change was highlighted by a number of reports, including the Shipman Inquiry report and later by reports about Mid-Staffordshire and Morecambe Bay NHS hospital trusts.

A priority of the system is to give bereaved relatives an opportunity to have a voice, ask questions and, if necessary, raise concerns. The attending doctor will sign the medical certificate of the cause of death (MCCD) after discussion and agreement with the medical examiner following review of the relevant patient records.

Medical examiners can offer GPs support with complex cases and administrative elements of notifications to coroners where agreed, thus reducing administration involved.

NHS guidance on their extension to primary care explains there is no need for a verbal discussion with the examiner unless the GP would find this helpful - an email exchange of correspondence will normally suffice. In most cases, the examiner will receive access to relevant parts of the patient records and practice staff may be involved in helping to put together a suitable summary.

Sharing patient records

Currently, the legal basis for the review of deaths by medical examiners is set out in The National Health Service Trust (Scrutiny of Deaths) (England) Order 2021. This order gives power to NHS trusts to scrutinise any death in England, regardless of whether the death takes place in the trust's area. This includes deaths in the community, where the coroner does not have a duty to investigate. Deaths can also be scrutinised by a medical examiner if there is doubt as to whether a death must be notified to the coroner.

All healthcare providers need to develop and implement arrangements to share medical records of deceased patients with their local medical examiner office.

When the statutory medical examiner system starts, there is an expectation that there will be a modification of the Access to Health Records Act 1990, to include medical examiners in the list of persons with a right of access to patient records.

Prior to this, the current provision for information governance and data protection under Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 ('section 251 support') allows the sharing of records for the purposes of scrutinising a death.

GPs with queries about certifying deaths or the role of medical examiners are welcome to contact the MDU for further advice.

For more information, read our guide on signing death certificates and cremation forms.

A version of this article first appeared in GP Online on 22 January 2024.

This page was correct at publication on 22/01/2024. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.