From Monday 9th September, changes in the law come into effect that may change your experience of registering deaths.
Medical Examiners Service
A new statutory medical examiner system is being rolled out across England and Wales to provide independent scrutiny of deaths, and to give bereaved people a voice. From 9th September all deaths in any health setting that are not investigated by a coroner will be reviewed by NHS medical examiners. These are independent senior doctors trained in the legal and clinical elements of the death certification process.
The purpose of the medical examiner system is to:
- provide greater safeguards for the public by ensuring independent scrutiny of all non-coronial deaths
- ensure the appropriate direction of deaths to the coroner
- provide a better service for the bereaved and an opportunity for them to raise any concerns to a doctor not involved in the care of the deceased
- improve the quality of death certification
- improve the quality of mortality data.
Medical examiner offices in England are based at acute trusts and in Surrey Heartlands there are offices at East Surrey, Royal Surrey and at Ashford & St Peter’s Hospitals NHS Foundation Trusts. They are staffed by teams of medical examiners, supported by medical examiner officers.
The role of these offices is to examine deaths to:
- agree the proposed cause of death and the overall accuracy of the medical certificate of cause of death (MCCD) with the doctor completing it
- discuss the cause of death with bereaved families and establish if they have questions or any concerns with care before death
- act as a medical advice resource for the local coroner
- identify cases for further review under local mortality arrangements and contribute to other clinical governance processes.
The most noticeable changes that come in on 9th September relate to the medical certificate of cause of death (MCCD) and the cremation paperwork.
New Medical Certificate of Cause of Death
The ‘medical certificate of cause of death’ is the certificate completed by the doctors who looked after the deceased. This is the certificate that goes to Surrey Registration Services and the information from this is added to the ‘Death Certificate’ that the Registrar will give you. From 9th September, medical examiners will be required in law to review every death in England and Wales that is not investigated by a coroner. To confirm this review has been completed the medical examiner countersigns the new version of the medical certificate before it can go the Registrar.
New Point of Contact
The three medical examiners offices for Surrey Heartlands become a point of contact for families after bereavement. We can tell you if we have received notification of the death, and if we have, where we are in the process of review. There are instances where our review may indicate a referral to the coroner is required. The commonest reason for this would be because the doctors attending the deceased may not be certain of the cause of death. Other reasons might be because the deceased had a fall and fracture or was undergoing treatment. The medical examiners team will be able to explain why the referral is needed and support with contact details for the coroners office.
Registering the Death
We strongly recommend you do not book a funeral date until the medical examiners office has contacted you to confirm an MCCD can be issued. There are two reasons for this:
- the medical examiner team cannot start reviewing a death until they have received all the paperwork from the attending doctor (currently 2-5 days after the death)
- review might indicate a coroner’s referral is necessary which means an MCCD may not be issued
Where it is possible to proceed with an MCCD, the medical examiners team will contact the Next of Kin as documented in the medical records, explain the certificate, answer any questions and if all is well give them the go-ahead to make an appointment to register. We can also help with explaining next steps. Families have five days to register a death from the moment registration services receives the MCCD from the medical examiner office.
MCCDs are sent to Registration Services electronically. There is no need to come into the hospitals or GP practices to collect a certificate.
Cremation paperwork
All deaths taking place after midnight on the morning of 9th September 2024 will not need cremation paperwork. This role is taken over by the new MCCD with the medical examiner review. For this reason, Surrey Registrars will be unable to accept or process a new medical certificate of cause of death unless it has both the signature of the attending doctor and the signature of the medical examiner.
Still have questions?
If you have questions or concerns about the care the deceased received, the medical examiners team will do their best to explain what they can from the medical records. If needed, we will help you access answers to your questions by linking you up with the NHS organisation who provided that care through their Patient Liaison services or Complaints process. If you feel a coroner needs to be involved, we can facilitate that for you.
Finally ...
All three Heartlands medical examiner offices having been working hard over the last three years, together with Surrey Registration Services, to minimise the impact of the change in the law on 9th September 2024. This will be a major change for healthcare professionals, registrars and funeral services but we all have the goal of creating a seamless transition for families going though bereavement. Your feedback will be invaluable in helping us to continuously improve this service.
Surrey Heartlands Medical Examiners Offices
Ashford & St Peter’s Hospitals
In Hospital: 01932 722299
NW Surrey and East Elmbridge: 01932 726588
East Surrey Hospital
In Hospital: 01737 768511
Royal Surrey Hospital
In Hospital: 01483 571122 ext 3605
Guildford & Waverley: 01483 303361
Further Information
- Death Certification Reform: Health and Social Care Act 2022
- The National Medical Examiner System – NHS England
- Death and Bereavement – GOV.uk
- What to do after a death – Surrey County Council
