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At the heart of general practice since 1960

GPs face death form probes

death

certificates

All death certificates for burials and cremations will be scrutinised for suspicious circumstances by an independent 'medical examiner', the Government has announced.

The medical examiner, who will be attached to a PCT or hospital trust, will have full access to medical records and may discuss the death with the deceased's family and certifying doctors. Any suspicious cases will be referred to the coroner.

Death certificate statistics will be collated and analysed by the trust's clinical governance team to ensure there are no

'unusual features', the Government announced in Learning from Tragedy, Keeping Patients Safe, published last week in response to the Shipman Inquiry.

Dame Janet Smith, who led the Shipman Inquiry, criticised lack of independent medical scrutiny of death certificates for burials or routine analysis of death certificate data.

Dr John Grenville, a Derby GP and BMA Shipman Inquiry adviser, said: 'This will make it harder for another Shipman, but finding him would not be guaranteed.'

GP errors that previously would have been undetected may also come to light, he added. 'In Victorian times people used to say that doctors buried their mistakes.' But Dr Grenville said the process could provide useful data on clusters of deaths from particular diseases.

The Government will also consult the RCGP and other interest groups on plans for every GP to have a 'death register'. And it will explore using practice-level mortality data to improve clinical governance, such as by comparing it against the NHS Information Centre database of mortality rates.

Dr Benny Beaumont, a London GP who has investigated the usefulness of monitoring practice's death rates, warned this would only give a crude guide.

'If you want to work out whether death rates were outside the normal range you would have to look at lots of factors, such as the age of patients, diseases they had and how many were in nursing homes.'

Professor Richard Baker, professor of quality and healthcare at the University of Leicester, who helped identify which of Shipman's patients died suspiciously, said death-rate statistics alone are unlikely to uncover another Shipman.

But he added: 'There is a fantastic opportunity for studying data not just on death, but on non-fatal outcomes.'

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