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Nothing as certain as death and taxes

Dr David Turner

Nothing is certain in life, except death and taxes, they say. Oh yes, well what about more unnecessary red tape in the health service? I’d say that was pretty much as dead a cert (no pun intended) as a final meeting with the Grim Reaper.

Yes, a whole new raft of administration around reporting of death is about to hit us. The national medical examiner system is being rolled out across England and Wales to provide greater scrutiny of deaths.

The official line on this is that ‘medical examiners can offer GPs support with complex cases and reduce administration’.

The phrase ‘offer GPs support’ sets my bullshit detector twitching like a Labrador’s nose in a butcher’s shop. Let’s not forget that the CQC offered to ‘support’ practices with helpful phone calls during the height of the Covid pandemic last year.

Also, unless I’m very much mistaken, we already have a system to support us with complex deaths. It’s called the coroner.

The system we have for reporting of deaths isn’t perfect, but of all the problems the NHS is currently dealing with, I’d say that it’s pretty low down the pile of things to change.

When a patient dies, it’s usually an expected death where certification is straightforward, or a non-expected death, where, nearly always, we have to refer the case to the coroner. There is a middle area of patients who were an expected death but were not seen in the (now 28-day) window of time by the GP before death. For most of these, all that’s usually needed is a chat with the coroner’s officer, and mostly they can be certified by us.

I see no need to introduce a whole new layer of bureaucracy at a time when we’re shorter of doctors than ever before. Because the kicker to this is that these new officers will be GPs. Yes, qualified doctors who could be on the frontline will be siphoned off to become jobbing medical examiners. I can imagine that there will be plenty of GPs sick of the daily grind who will be glad to take on some (almost certainly well-paid) back office administration work, but that doesn’t mean that it should be enabled. Yes, the day job is tough, but it always has been and, for better or worse, we signed up to it.

Over 20 years on, this latest layer of bureaucracy has a sniff of post-Shipman regulation about it. I’m afraid that I see this as a further reinforcement of the message that has come down from ‘on high’ for a long time – ‘GPs cannot be trusted’.

Luckily for us, the public disagree, and trust doctors above almost any other profession.

Perhaps we should get this message engraved on brass plaques and fixed to all our surgery doors?

Dr David Turner is a GP in Hertfordshire


Patrufini Duffy 24 August, 2021 10:07 pm

Death. That word needs to be said more in life and medicine. Day it to yourself daily when you get caught up in mind games and bullying. It adds a layer of truth, perspective and direction, to purposeless burecracy, opaque avalanches and sleep-walking automations.