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New medical examiner system postponed to September

by Eliza Parr
22 April 2024

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The implementation of a new system requiring GPs to agree death certificates with a medical examiner has been postponed to September, the Department of Health and Social Care (DHSC) has confirmed.

Last week, the DHSC laid regulations in Parliament that will, following multiple delays, put the medical examiner system on a statutory footing from 9 September.

This also means that changes to simplify the death certification process for GPs, such as the cremation form becoming redundant, will not come into force until September.

It is understood that GPs in some areas are already using the system, which sees medical examiners (MEs) providing independent scrutiny of all deaths in the community not taken to the coroner, but the necessary legislation has been repeatedly postponed.

As recently as last month, there were concerns around the implementation of the system, which seemed unlikely to launch at the beginning of April as planned.

Now, the Government has confirmed an official September start date, emphasising that the death certification reforms are ‘highly complex and sensitive’, and that it has ‘allowed additional time to prepare for implementation’. 

The system has been developed in part as a response to the GP Harold Shipman’s murder of his patients, and the Lucy Letby case, which both ‘highlighted the need for an extra layer of scrutiny’. 

From 9 September, any GP who has ‘attended the deceased in their lifetime’ will be eligible to be an attending practitioner, which simplifies the current requirements whereby GPs or clinicians are only eligible if they have attended the patient during their last illness.

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 statutory system was formally introduced by the Health and Care Act in 2022 and NHS England wrote to GP practices in England in July last year asking them to implement processes to facilitate the work of medical examiners by 31 March 2023. 

In December, DHSC said GP practices should ensure they make ‘the necessary arrangements’ to share records of deceased patients, recommending these processes are set up ‘with immediate effect’. 

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 medical certificate of cause of death (MCCD).

Health minister Maria Caulfield said the new measures will make the system ‘safer by improving protections against rare abuses’ and will ensure the bereaved are kept ‘fully informed’.

‘Reforming death certification is a highly complex and sensitive process, so it was important for us to make sure we got these changes right,’ she added.

In Parliament, the minister said: ‘This is the most significant set of reforms to death certification in 70 years and we have allowed additional time to prepare for implementation. 

‘We are working closely with our partners in Government, local registration services, coronial services and the health service to ensure that the appropriate operational processes are in place to deliver these changes in September 2024. 

‘There will be further communication regarding legislative changes and operational guidance between now and September 2024.’

Dr Suzy Lishman, senior advisor on medical examiners for the Royal College of Pathologists, which is the lead college for MEs, said doctors in this role are ‘already scrutinising the majority of deaths’ in England and Wales.

‘The move to a statutory system in September will further strengthen those safeguards, ensuring that all deaths are reviewed and that the voices of all bereaved people are heard,’ she added.

Earlier this year, the BMA warned that the new medical examiner system will be ‘administratively burdensome’ for GP practices, and that some MEs may not have capacity to provide scrutiny for community deaths within ‘reasonable timescales’.

A version of this story first appeared on our sister publication Pulse.