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Your first... death at home

When a patient dies unexpectedly at home and you or colleagues haven't seen them within two weeks, the certification process is a bit more complex, advises Dr Stefan Cembrowicz

When a patient dies unexpectedly at home and you or colleagues haven't seen them within two weeks, the certification process is a bit more complex, advises Dr Stefan Cembrowicz

Deaths at home are different. Patients may die suddenly and unexpectedly, or following planned terminal care involving major use of GP resources.

Should someone die expectedly at home, and you or a colleague in the practice have seen them within two weeks, you simply arrange with the relatives to issue a death certificate for them to collect, usually the next day in your surgery, and advise them that they are able to contact an undertaker of their choice to arrange for the body to be moved.

This entitles them to register the death and arrange a funeral. The form is the same as you will have filled out in hospital.

As a general rule, if someone has not been seen by a doctor within two weeks of death, you are not able to certify their death. If so, you must notify the coroner's officer, who will then take over the arrangements, organise a postmortem and issue the death certificate.

Call your local police station who will put you through to the coroner's officer, or send an officer as his deputy if it is out of hours. You should reassure relatives that this is a formality, as a uniformed officer will be arriving to make the arrangements.

There is some leeway and you can always discuss cases with the coroner's officer. If you are reasonably clear about the cause of death – for example, a terminal care patient who had been seen regularly by district nurses, but who had not seen you for somewhat longer than two weeks – the coroner may agree that a postmortem is unnecessary and permit you to issue a death certificate.

Contact the relatives

You should be notified when a patient dies in hospital. It is good practice when this happens to contact the relatives to offer your condolences and to see if there are any unexplained issues. Family members may want to have a cause of death explained in plain English. A word with hospital staff who cared for the deceased can then be helpful.

Cremation forms require inspection and identification of the body, usually at the undertaker's. As the doctor involved you need to complete the first part of the form, and then contact an independent doctor with enough details (including contact numbers of family, nurses or other doctors involved) for them to complete the second part.

A general external inspection usually suffices; remember to check the ID bracelet. Make sure there is no pacemaker present.

Question 10: Mode of death – the terms often appear to be misunderstood. Syncope implies cardiac or cerebrovascular death, but convulsions may imply an unnatural death.

Remarkably, old age is apparently still acceptable as a cause of death, though only where multiple pathologies co-exist, rather than when the cause is unascertained.

As it is not part of your NHS duties, a fee is payable for the completion of a cremation form. Check with your trainer whether your contract entitles you to keep cremation fees. If so, they have to be declared on your tax return and, yes, they certainly do check.

Stefan Cembrowicz is a GP trainer in Bristol

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