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Covid-19 Primary Care Resources

Death certification

A summary of current guidance and when to discuss with the coroner

This information is sourced from NHS Improvement and the RCGP:

Certification of death

Prior to the coronavirus outbreak, in order for the MCCD to be accepted by the registrar without referral to the coroner, it had to be issued by a doctor who had attended the patient in life and had seen them in the two weeks before death

This time-frame has now been extended to have been seen in the 28 days before death, or after death

The MCCD can be done by a doctor who didn t know the patient in life if:

  • The usual GP is unavailable
  • The GP who signs the MCCD knows the cause of death to the best of their knowledge and belief
  • A doctor has seen the patient within the 28 days before death or after death

The MCCD should be signed, scanned (both sides) and emailed to the registrar

Find out if your local registrar wants the original to be sent in the post, or kept at the practice for collection at a later date

Covid-19 can be put on the death certificate on clinical balance of probabilities, without testing. If you are waiting for a swab result, record this fact in box B on the back of the certificate

Patients not seen within the last 28 days:

  • If a patient dies without seeing a doctor in the 28 days before death, and has not been seen after death, you need to inform the coroner in writing
  • In this situation you should sign the MCCD and send it to the coroner circling number 4 on the MCCD to indicate that a discussion has been had with the coroner
  • The coroner will complete their own paperwork, called a form 100A and send it on to the registrar
  • If the patient is being cremated, fill in the cremation form and let the funeral director know that the coroner is involved, has authorised the signing of the MCCD and will be filling out a form 100A

Discussion with the coroner

Covid-19 is a notifiable disease, but this fact in itself does not mean that every case needs to be referred to the coroner

Usual reasons for referring to the coroner still stand. These include:

  • Being unable to state a cause of death (e.g. a sudden death in a previously healthy person)
  • A death which was known to be violent
  • A death contributed to by industrial disease
  • A death where the patient had not seen a doctor for over 28 days before they died
  • A death in state detention (e.g. prison) needs to be reported to the coroner

Ethical issues

BMA guidance reminds GPs that the procedure of certification can provide a valuable safeguard against wrongdoing and anyone involved in the process should raise any concerns as a matter of urgency.

A BMJ editorial reminds doctors that:

  • Thorough scrutiny of deaths remains essential during the covid-19 epidemic
  • In normal times, the Ministry of Justice guidance on reporting of death to a coroner is underpinned by the definition of an unnatural death
  • An unatural death is a death which has not resulted entirely from a naturally occurring disease process running its natural course, where nothing else is implicated
  • This definition is important because it covers several likely scenarios during the pandemic; deaths from Covid-19 when late diagnosis or lack of treatment availability may have been a factor; when treatment is denied or withdrawn from vulnerable patients because of scarce resources; and deaths of health and care workers, particularly those associated with late or no testing or lack of protective equipment