GPs in England and Wales will have a statutory obligation to engage with medical examiners for all non-coronial deaths from April next year, the Government has confirmed.
Draft regulations, published today, will be laid in parliament in ‘early 2024’ and will require all deaths not investigated by a coroner in any health setting to be certified by a medical examiner (ME).
The new statutory system will mean GPs, as an attending practitioner, are legally required to agree death certificates with the medical examiner at a local hospital trust.
Any GP who has ‘attended the deceased in their lifetime’ will be eligible to be an attending practitioner, according to the new regulations.
This will simplify the current requirements whereby GPs or clinicians are only eligible if they have attended the patient during their last illness within the 28 days prior to death.
The Government failed to meet its original deadline for bringing in this legislation, but many regions are already using the system.
GPs flagged that the necessary legislation to mandate the system was missing, and one LMC leader called the implementation a ‘car crash’.
A month later, the Government admitted to the delay and committed to legislating by April 2024.
The statutory system was formally introduced by the Health and Care Act last year and NHS England wrote to GP practices in England in July asking them to implement processes to facilitate the work of medical examiners by 31 March 2023.
These changes to the death certification process are intended to ‘help prevent criminal activity and poor practice’ by making sure the ‘right deaths’ are referred to coroners.
Medical examiners can increase transparency for bereaved families and give them a chance to ask questions and raise concerns.
The role is a senior medical doctor who is trained in the legal and clinical elements of death certification.
The process means GPs have to give access to a deceased patient’s records in order for the ME to reach agreement on the accuracy of the medical certificate of cause of death (MCCD), where before this extra scrutiny was not required.
The Department for Health and Social Care (DHSC) has said GP practices ‘must ensure they make the necessary arrangements to inform medical examiners of deaths requiring independent scrutiny and share records of deceased patients with medical examiners in a timely manner’.
New guidance recommends that GP practices ‘set up processes with immediate effect’ if they have not already done so.
‘This will avoid disruption and distress when the regulations come into force, allow procedures to bed in, and enable issues to be identified and addressed,’ the guidance added.
In February, temporary permission was granted by the Confidentiality Advisory Committee (CAG) to medical examiners to continue accessing deceased people’s records until March 2024. This permission has been extended twice since initial approval in 2021.
Process for GPs attending deaths from April 2024
3. (1) An attending practitioner in relation to a death must, as soon as practicable after becoming aware of that death –
a) review –
i) the deceased person’s relevant health records;
ii) the results of any physical examination of the body of the deceased person undertaken by the practitioner or any other registered medical practitioner; and
iii) any other information which the practitioner considers relevant, with a view to establishing the cause of death to the best of the practitioner’s knowledge and belief;
b) either –
i) prepare and sign an attending practitioner’s certificate; or
ii) where they are not able to establish the cause of death, refer the death to a relevant senior coroner; and
c) where they have prepared and signed an attending practitioner’s certificate, make available to an appropriate medical examiner –
i) the attending practitioner’s certificate; and
ii) the deceased person’s relevant health records and any other information considered under paragraph (1)(a).
Source: DHSC
The regulations also stipulate that GPs acting as attending practitioners must ‘be available, as far as reasonably practicable, to respond to any enquiries that the appropriate medical examiner may have’ in connection with the MCCD.
Currently, for non-coronial deaths, GPs must complete a form if patients are to be cremated, however the new statutory system will make this form ‘obsolete’ since information about medical devices and implants in the body must be included as part of the MCCD.
As of September, medical examiners had reviewed 640,000 deaths in hospital trusts since 2019.
The system has been developed in part as a response to the GP Harold Shipman’s murder of his patients – the 2003 inquiry proposed that the account of events given by a doctor should be cross-checked.
In March, the BMA highlighted that the new GP contract does not stipulate that GPs must agree death certificates with a medical examiner, and Pulse reported that the ME system was included in the union’s list of ‘bureaucratic items’ that should be completed elsewhere to reduce GP workload.
DHSC minister Maria Caulfield admitted that it has ‘taken time to get this right’, but emphasised the importance of getting buy-in from everyone involved in the process.
She said: ‘Although abuse of the system is rare, what we are announcing today will be a significant step in preventing failures in the future.’
National medical examiner Dr Alan Fletcher said he has seen the ‘care’ MEs take to ‘support bereaved people, increase safeguards, and identify opportunities to improve care’.
‘Medical examiners ensure that if bereaved people have concerns after their loss, these can be raised as easily as possible, which is why it is great to see this progress towards a comprehensive system,’ he said.
Dr Suzy Lishman, senior medical advisor on MEs for the Royal College of Pathologists, said they are ‘already scrutinising the majority of deaths in England and Wales’.
She added: ‘The move to a statutory system in 2024 will further strengthen those safeguards, ensuring that all deaths are reviewed and the voices of all bereaved people are heard.’
And where are all the new Medical Examiners going to come from ? The existing pool of Doctors. Sounds like a nice low stress gig. However from the functioning of Primary Care as a whole it will take hundreds Doctors away from the coalface.
We’re already “engaging” with med examiner service in York and I don’t find it particularly onerous. I don’t know how happy families are with the additional 48h delay in producing a death cert though!
But for me the carrot of “no need to view the body if pt not seen within last 4 weeks” will certainly compensate for the stick of “must get certs approved by medical examiner”
The same old bunch of patient avoiding GPs in many cases have entered this highly paid administrative arena and there seems to be no shortage – who is to say that this group themselves do not need looking at and overseeing. These types of pen pushing jobs are diluting the pool of GPs remaining in practice and are far less onerous roles which should be paid at a maximum of half normal GP rates in order to reduce this attrition in areas of real need. Furthermore, in some areas pathologists who may not have seen a live patient for decades or have any experience of looking at GP patient notes/policies/procedures will be checking these death certificates – how is experience of looking at dead bodies suitable for this position?
Already happening in hospitals. I cannot see how this extra email to ME s office should impact on the job as a whole. How many deaths a month we talking? You are spending time reviewing the notes to sign the paperwork anyway, one extra email about something you are already doing is not going to make a difference. And the 28 day rule goes out of the window!
Dear All,
My reading of the regs recently published doesn’t really change a thing. The attending practitioner (GP) still has to complete the death certificate. They then have to inform the ME. However they are only ever “invited” by the ME to consider revising the death certificate, there is no compulsion for the GP to do as the ME suggests. Maybe they’ve changed the regs?
Anyway notice that te GPs been given more work and at the same time had a source of income that went to paying for the work taken away? Familiar story.
Regards
Paul C
Form ME1 Part A seems to require at least as much info as required for (Crem) Form 4, but for every death, including burials?
I think it is staggering that the one effective anti-Shipman measure has taken 20 years to implement, but the revalidation which would not have stopped him came in years ago.
I can see a new period of uncertainty
Clearly nothing to be lost on my part in referring all cases to the coroner. That would obviate the possibility of the examiner routing through my records and finding my conclusions/ cause of death wanting
Nothing more certain than a post mitten
The ensuing chaos would perhaps if widely accepted uncertainty infected a good number lead to a restoration of an older school approach where our judgment was seldom questioned and we were not faced with yet another insult on our already pressured time