The Department of Health has postponed plans to increase the scrutiny placed on GPs during death certification through the introduction of new medical examiner checks on cause of death, amid a funding row with local government.
The new system, which will see GP and doctor accounts of cause of death cross-checked with a family member and health records released by GP surgeries and other health institutions for an ‘independent’ confirmation of the cause of death, was due to be rolled out in October 2013.
But the scheme has now been put back until April 2014, after the DH found itself caught in a row with local government over how the medical examiner’s fee will be funded. The DH is intending to hand the responsibility of sourcing the funding to local government, but said further consultation is needed to help local government make ‘an informed choice’.
The BMA has stated clearly to the DH that it thinks the fee should be covered by a central tax rather than grieving families.
In a letter to public health directors on 8 August, Professor John Newton, lead regional public health director on death certification reforms, said: ‘The collection of the medical examiner fee continues to be a challenge. The costs associated with collecting the fee have a direct bearing on the fee that the public may need to pay if the funding option for the medical examiner service continues to be funds generated by the medical examiner fee.
‘The programme team have been made aware of some options – namely online payment, billing by local authorities, payment at the register office and arrangements between local funeral services and local authorities. The decision on the options will be entirely a local matter, but the consultation document will need to set out the options and costs so that local authorities can make an informed choice. All the options have raised issues for further consideration.’
The row comes as results of the DH pilot study into the system has indicated there could be errors in as many as one in four death certificates, while one in 10 points to the wrong cause of death altogether. The statistics – from a pilot site in Sheffield – are the first data to come out of the wider Government pilot scheme, with national results due to be published shortly.
Anne Milton, public health minister, said: ‘Our plans to reform the system of death certification will improve the accuracy and robustness of information we record on the causes of death. This is not only important for families, but will help with public health surveillance and local health service planning. Critically it will also help with the early detection of poor-quality care.
‘A study is being carried out using the information from all the pilots, looking specifically at the causes of death following a medical examiner’s scrutiny. The findings of this will be published shortly.’
A comparison study of the potential impact on mortality statistics, following medical examiner scrutiny, is being carried out by the Office for National Statistics using data from the death certification pilots.
The DH has said the planned enhanced scrutiny of cause of death, prompted by the Shipman inquiry, will be important not only for families, but also in health services planning.
The DH also said that all doctors with an NHS email address with an interest in the medical examiner role can now log on to the e-Learning for Healthcare website and register their details for access to the medical examiner e-learning training modules.