The good old days where GPs rang the coroner’s officer – who they were probably on first name terms with – to explain the circumstances of a death are long gone.
At that time, we would be called back within a few hours and given permission to issue a Medical Certificate of Confirmation of Death (MCCD).
The rules allow for communication by e-mail, web portal or other electronic portal. In pilot sites, this has been a web portal.
In my experience of using the web portal, it took up to 20 minutes to record all the details required and frustratingly needed a ‘nil’ response in some boxes to accept and upload the data. The coroner’s office acknowledges receipt of the data by e-mail, usually the following day, and then may ring to discuss the case and determine who can issue the MCCD and what should be on it.
Under new legislation brought in at the beginning of October, all deaths reported to the senior coroner must be in writing
The regulations allow for oral reporting in ‘exceptional circumstances’ only. Kent LMC met with the senior coroner to see if any flexibility could be considered and the answer was not positive. If our IT fails, we are still expected to report electronically. It will only be the failure of the web portal which would allow for oral reporting and there is no flexibility regarding the information required.
GPs and practices need to factor in how these changes will affect day-to-day practice and try and mitigate for the delays this system is creating for bereaved families and their funeral directors.
In practice, any death which needs reporting to the coroner should be done as soon as practically possible. This means a GP who does not know the patient may have to enter the details on the web portal.
The deaths that need to be reported are those that GPs are accustomed to reporting which include poisoning, violence, trauma, neglect, employment related or those due to some form of human failure. Deaths in custody must be reported but this does not include those subject to a Deprivation of Liberty Order (DOLS).
In addition, where a death may have already been reported – for example by a police officer when a patient is found deceased at home and no obvious cause is known – there is still an obligation to report. In the past, the corner’s officer would phone to ask for additional information. GPs now have an obligation to report.
The details required in reporting include the information about the demographics of the patients and a narrative explanation of the circumstances leading to the death. However, they also require information about who the next of kin is or alternatively who is responsible for the disposal of the body, which could be a local authority.
This is not information that is necessarily recorded in GP records. It may be worth adding this information to the records of the elderly or end-of-life patients. In time, it may make sense to record it for all patients.
The new rules allow for a case to be discussed with a ‘medical examiner’.
This new role has been piloted in some areas but is not yet available in primary care. It is due to be implemented next year and will lead to unification of the death certification process and the end of cremation forms. It also will allow for discussion around uncertain causes of death with a medically qualified official.
The new rules allow for a case to be discussed with a ‘medical examiner’
The new rules also state that an MCCD can be issued by an ‘attending practitioner’ who has seen the deceased in the last 14 days of life or after death.
Previous guidance said ‘and after death’ but, with the new wording, it may be possible to avoid reporting a death by viewing the body after death.
Where the GP who could complete the MCCD is not available due to holiday or other reasons, then the death will need to be reported to the coroner.
Practices should consider ‘handing over’ end-of-life patients when the attending GP is going to be on holiday in order to avoid having to report to the coroner. I have deliberately visited an EOL patient in this situation so I can legally certify without referring to the coroner.
In summary, the advice to practices is to avoid having to refer by
• Handovers of end-of-life patients
• Good record keeping including next of kin details
And if you do have to refer to the coroner
• Do it swiftly
• Keep good records
Dr John Allingham is medical secretary of Kent LMC and a GP in Kent