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NHS England removes provision for ‘any’ doctor to sign death certificate


death certification


GPs signing death certificates will now need to have ‘attended’ the patient in the 28 days preceding their death, or viewed the body in person after death.

During the pandemic, any doctor could sign the Medical Certificate of Cause of Death (MCCD), regardless of whether they were the medical practitioner to have attended.

This provision was part of guidance released during the pandemic to allow for the fact that death may occur in self-isolating households.

But new guidance said that ‘the provision for any medical practitioner to complete the MCCD, introduced as a temporary measure by the Coronavirus Act, will be discontinued when the Act expires at midnight on 24 March 2022’.

It also said: ‘A medical practitioner with GMC registration will be able to sign the MCCD if they attended the deceased during their final illness up to 28 days before death, or viewed the body in person after death

‘Attended’ does include through ‘consultation using video technology’, but not by telephone, the guidelines confirmed.

However, the new guidance states: ‘Attendance after death (i.e. viewing the body) will need to be in person and includes verifying the death.’

But NHS England has also announced that some pandemic changes to the death certification process will be permanently retained.

In updated guidance, NHS England said changes that will remain are:

  • The period before death within which a doctor completing a MCCD must have seen a deceased patient will remain 28 days (prior to the coronavirus pandemic, the limit was 14 days);
  • It will still be acceptable for medical practitioners to send MCCDs to registrars electronically;
  • The Government’s intention is that the form Cremation 5 will not be re-introduced after the Coronavirus Act expires.

But Dr Paul Cundy, a member of the BMA’s GP Committee who has been following the death verification issues closely, has written an open letter saying he is ‘concerned’ by the ‘incorrect’ guidance as it is ‘placing doctors at risk and with unnecessary and burdensome work’.

Dr Cundy’s letter refers to the Births and Deaths Registration Act 1953, and highlights there is ‘no reference to timing, chronology nor of seeing or viewing the deceased after death’.

He asked for an ‘immediate correction’ to be issued, and said he is ‘already advising GPs accordingly’.

It comes as the Ministry and Justice indicated in 2020 that coroners have no legal powers to tell GPs they must confirm a death in person. 

It followed coroners clashing with the BMA over who could verify a death during the pandemic, and saw the BMA threaten legal action.

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, the registrar will inform the coroner
  • In this situation you should sign the MCCD and send it to the coroner circling number 4 on the MCCD if 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

Source: Pulse Covid-19 toolkit

Note: This article was updated at 10.45 on 16 March to reflect that a GP does not need to have seen a patient in person after their death if they had consulted them in person, or via video, in the 28 days preceding their death,

READERS' COMMENTS [4]

David Church 14 March, 2022 10:37 am

They really should get it right first time.

paul cundy 14 March, 2022 1:00 pm

Dear All,
Ignore the headline its wrong. You can access my open letter here

https://www.dropbox.com/s/doaqzwf2k1wcjqx/MCCD-Open-letter.pdf?dl=0

That explains everything. I did ask Pulse to point to it but they decided not to.
Regards
Paul Cundy

Katharine Morrison 14 March, 2022 6:07 pm

Well done Paul. We don’t need GPs to be doing any extra work at the current time.

Harold Hellfire 18 March, 2022 11:47 am

Fantastic work Paul 👏