Please see the email and attachments below from the LMC, regarding the new death certification regulations

Dear colleague,

I am writing further to the letter sent to practices last week on behalf of Mr Ellery, Senior Coroner and after consultation with his team. I hope this helps to provide further clarification of the changes.

All registered medical practitioners who attended the deceased during his/her last illness (prior to death) must complete a MCCD by law if they know the cause of death and it is a natural cause.  ‘Attended’ is usually accepted to mean a face-to-face consultation.  There is no need for contact to have been within the previous 14 days.

The Registrar however requires the issuing Doctor to have seen the body after death if they have not seen the patient within the 14 days before death.

Hitherto, it has not been a legal requirement for the GP to report any death to the Coroner. That has now changed. The Notification of Death Regs 2019 (implemented 1/10/19) sets out a list of circumstances/possible causes of death that require the GP to refer the death to the Coroner.

The other change is where no ‘attending’ doctor is available to complete a MCCD within five days of the death. Another doctor has to report the death to the Coroner – who may then direct them to complete a MCCD.

So in summary:

 

• Attended in the last illness – complete an MCCD

• Attended in the last illness but requires referral under Notification of Death Regs 2019. The Coroner may allow you to issue an MCCD once he has concluded his enquiries

• Not involved in the last illness but know about it – Seek another qualifying GP to write the MCCD, or if one is not available – report to the Coroner

 

Even though there is no need for a doctor to have seen the deceased in the 14 days prior to death to issue a MCCD,  the Registrar will themselves refer the death to the Coroner if the patient has not been seen after death by the issuing Doctor.

Below are the answers to some questions I asked the Coroner’s Team:

 

• If a GP feels in a position to issue a death certificate he or she can do so even the patient has not been seen recently?

The answer to this is YES. Please be aware that Section 22 of the Births and Death Registration Act 1953 requires the Doctor issuing the certificate to have ‘treated the patient in the last illness’ to state the cause of death to best of their knowledge and belief, this legislation is not time specific. The Registrar however requires the issuing Doctor to have seen the body after death if they have not seen the patient within 14 days of death. It is an EITHER/ OR situation. Seeing the body after death is a recommendation by the British Medical Association for this reason.  A certificate issued by a Doctor who has not treated the patient in the last illness will be rejected in any event whether the Doctor has seen the body after death or not.

 

 

• The certificate will either be accepted or rejected by the Medical Examiner and the case referred to the Coroner?

Yes this would be a matter for the Medical Examiner however there is currently no statutory Medical Examiner system in place. Updates on the National Medical Examiner system can be found at  https://improvement.nhs.uk/resources/establishing-medical-examiner-system-nhs/  There is a Medical Examiner service in place at The Royal Shrewsbury Hospital but please be aware this is currently a voluntary system, funding is not yet available for a Medical Examiner service for Hospital and Community based deaths. Therefore please note that at present the Doctor will be issuing the medical certificate to the family for them to take directly to the Registrar’s Office.  If the certificate does not meet the requirements of the Births and Deaths Registration Act it is for the Registrar to refer the death to the Coroner. If the issuing Doctor has any questions please feel free to contact the Coroner’s Office for advice.

 

• Will GPs be able to obtain advice on what is best to do in specific cases?

It is to be expected that any new legislation takes time to get used to, G.Ps are free to contact the Coroner’s Office for advice.

 

• If a GP tried to issue a death certificate for a patient who had no known condition and no medical contact for a year I’m sure that would be rejected?

It is hard to envisage a scenario where a GP would try to issue a certificate in these circumstances as the cause of death is likely to be unknown and therefore reportable to the Coroner. Accepted guidance issued by the Office for National Statistics section 4.3 states that even if using ‘Old Age’ as a cause of death there must have been an observed gradual decline in the patients general health and functioning.

In all cases GP’s are expected to state the cause of death to the best of their clinical knowledge and belief and on the balance of probabilities.  If there any uncertainty from the Doctor as to whether the certificate can be issued please ring the Coroner’s Office for advice. We are here to help you.

Attached to this email is a flowchart that has been created to assist with the new Regulations, which your GPs may find useful.

FLOWCHARTDeath Certification & or Referral to Coroner