NEW: Medical examiner process

The statutory implementation of medical examiner system will be coming to all NW London GP practices (under legislation in the 2022 Health and Care Act).  

To be compliant practices must be ready to use the new process on EMIS/SystemOne to refer deaths to the Medical Examiner’s Office - before a medical certificate for cause of death (MCCD) can be issued, for non-coronial deaths.

User guides to set your practice up:

SystmOne - guide

EMIS - user guide

All practices should attend a training session to support set-up on these systems - please see the NW London primary care bulletin for dates and times.

If you have IT set-up questions and cannot attend one of these training days please contact: tsmith8@nhs.net

What is the change to the death certificate process and why is it happening?

The statutory implementation of medical examiner system for all GP practices started on 9 September (under legislation in the 2022 Health and Care Act), along with some changes to the medical certificate of cause of death (MCCD).

The medical examiner system has been successfully running in our acute trusts for the last few years and the rollout to primary care completes the final stages of the nationwide process.  A medical examiner will review the clinical notes to agree the cause of death with you or suggest a referral to the coroner. As part of the process the medical examiner will speak to the bereaved and talk through any questions they have.

 

What does this mean?

The change means that all non-coronial deaths (non-acute sector) need to be referred to the local medical examiner’s office before a death certificate can be provided.

This will be done using a new pathway set up on EMIS/SystmOne TPP.
User guides can be found on the tab above.

 

Which GP can can complete the death certificate (MCCD)?

Any GP that has seen the patient in their lifetime, even if only once, as long as they can identify the cause of death.

If no GP in the practice has seen the patient, the death will need to be referred to the coroner.

If the only GP (who has seen the patient in their life) is on holiday – it will need to be decided what timescale is reasonable to wait to complete the MCCD (e.g. 5-7 days). If the GP is away longer it will need to be referred to the coroner.
 

How do GPs complete the section of the MCCD on devices if you can’t see the patients notes?

If you don’t know, you do need to check. The medical examiner office may also be able to help you find out more information.

For patients you don’t have access to records, it may be advisable to visit the patient to see if they have any devices that can be felt.

A full list of devices will be provided by DHSC soon – the following list has been shared by our local crematoria.

Implants that could cause issues during a cremation include but are not limited to:

• Pacemakers
• Implantable Cardioverter Defibrillators (ICDs)
• Cardiac resynchronization therapy devices (CRTDs)
• Implantable loop recorders
• Ventricular assist devices (VADs): Left ventricular assist devices (LVADs), Right
• ventricular assist devices (RVADs), or Biventricular assist devices BiVADs)
• Implantable drug pumps including intrathecal pumps
• Neurostimulators (including for pain & Functional Electrical Stimulation)
• Bone growth stimulators
• Hydrocephalus programmable shunts
• Fixion nails (battery powered saline filled cylinders inserted in bone in eg sarcoma surgery to grow with the patient)
• Any other battery powered or pressurised implant
• Radioactive implants
• Radiopharmaceutical treatment (via injection)

 

Where do cross boundary referrals go?

Refer the death to the medical examiner service in the borough where the death happened – if a cross boundary then the ME offices may need to have a conversation about who best to review. Do not send more than one referral.

If the GP has sent to the wrong ME office – the ME office will forward on to the correct office.
 

What do I do if the coroner returns a referral?

If the coroner returns a referral for the practitioner to complete the MCCD, this must go to the medical examiner’s office.

CN1A and CN1B forms (returned by the coroner) mean no investigation required, so the referral needs to then go the medical examiner’s office.
 

What to do if you are unsure of the coroners advice?

Please speak to your medical examiner – they are there to help support and ensure the right process is followed

 

What does a medical examiner do?

Medical examiners (ME) are senior clinicians who act in a supportive role:

• agree the proposed cause of death with the doctor completing death certificate 
• discuss the cause of death with the next of kin/informant and establish if they have questions or any concerns with care before death
• identify potential learning and compliments to contribute to clinical governance procedures.

Will the new process cause delays to the bereaved?

There are additional steps in the process but they should not cause undue delays for the bereaved. Medical examiner review should happen within 24 hours. The GP will need to respond to the medical examiner review and together agree a cause of death. The final certificates will continue to be sent electronically to the registrar by the Medical Examiner.

The practice will need to inform bereaved relatives that they will receive a call from the Medical Examiner's office. Other than this call bereaved relatives/next of kin should not notice a difference in process.

Why is the medical examiner calling the family?

The medical examiner or medical examiner officer has the responsibility to ask the family if they had any concerns about the care of the deceased. This is the case even if the regular GP has been present in the home or visited afterwards as the medical examiner service is independent.

It also provides an opportunity for the bereaved to speak to someone independent of the deceased's care about their treatment.

What is the process - how will practices be informed of a death?

There is no change to the way that the practice will hear about a death in the community. Most are communicated from the relatives or friends of the bereaved, others from the out of hours GP service or community nurses, or the practice may receive a notification of deduction.

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How do we get the practice ready for the change?

Information will be shared with practices, but if you would like to talk to someone about getting your practice set-up. Please email: tsmith8@nhs.net
 

Who is my medical examiner– how do I contact them?

If you have any questions, please contact your local medical examiner office.

 

Borough of patient death	Medical examiner service base	Medical examiner office email
Hillingdon	Hillingdon Hospital	Thh.me-community@nhs.net
Harrow	London NW University Healthcare (Northwick Park)	LNWH-tr.medicalexaminerharrow@nhs.net
Hounslow	West Middlesex Hospital	chelwest.bereavementteam.wmuh@nhs.net
Brent	London NW University Healthcare (Northwick Park)	LNWH-tr.medicalexaminerbrent@nhs.net
Ealing	London NW University Healthcare (Northwick Park)	LNWH-tr.medicalexaminerealing@nhs.net
Royal Borough of Kensington and Chelsea	Chelsea and Westminster Hospital	Chelwest.medicalexaminer@nhs.net
Hammersmith and Fulham	Imperial College Healthcare	Imperial.medicalexaminer@nhs.net
Westminster	Imperial College Healthcare	Imperial.medicalexaminer@nhs.net

 

What resources will be available to help train staff?

Information for practice staff, IT training support and information for the public can all be found on these pages.

Information is regularly shared with practices, therough the bulletin and email to ensure they are set up correctly on SystmOne/EMIS.

You can also listen to this national podcast.

 

What happens after a loved one dies and how do you go about registering the death?

This information has been provided to introduce you to the role of the medical examiner and explain why they will call the next of kin following a bereavement.

Watch our video or read more below.

Losing a loved one is never easy and it can be difficult and confusing having to think about what you need to do to register the death when you are grieving.

To help you understand the process we’ve put together a simple guide of what happens next and what you will need to do.
 

1. Phone call from the medical examiner’s office

As soon as possible after the death (on average within 24 hours) the next of kin will receive a phone call from the medical examiner’s service. This service provides an independent review of the cause of death and gives the next of kin time to ask questions.

(Medical examiners are senior medical doctors who provide independent scrutiny of the causes of death. They are trained in the legal and clinical elements of death certification processes. The medical examiner’s service was rolled out nationally in September 2024 to all community and GP services. You can find out more here).

The medical examiner’s office will be able to:

• confirm your loved one’s cause of death
• discuss the care they received
• answer your questions, and concerns
• explain the wording on the death certificate agreed by the doctor and medical examiner.
   

If the cause of death is unknown, they will also be able to talk you through the referral process to the coroner (if required).

Following your call with the medical examiner’s office the medical certificate of cause of death will then be electronically sent straight to the registrar in the borough the death was recorded. You will then be able to book an appointment to register the death.

You do not need to visit the GP surgery to collect the medical certificate of cause of death.
 

2. Registering the death

A death must be registered within five days.

To register you will need to book an appointment with the registrar in the borough that the death occurred in. The registrar will need the medical certificate of cause of death to do this.

Please use the links below to register in the borough you need;

• Brent: Deaths and funeral arrangements | Brent Council
• Harrow: Register a death – Register a death – Harrow Council
• Ealing: Register a death | Register a death | Ealing Council
• Hillingdon: Register a death - Hillingdon Council
• Hounslow: Register a death | Register a death | London Borough of Hounslow
• Hammersmith and Fulham: How to register a death | LBHF
• Kensington and Chelsea: Deaths | Royal Borough of Kensington and Chelsea (rbkc.gov.uk)
• Westminster: Register a death | Westminster City Council

 

3. Arranging a funeral

A funeral can usually only take place after the death is registered.

There are many things to think about and decide when arranging a funeral. The person may have left plans for the funeral they want, or you may need to arrange the funeral yourself. It can be a good idea to ask family and friends for help. Or you may want to pay for the services of a funeral director, who can take you through the whole process step-by-step.

Whilst planning a funeral, it can be useful to consider: 

• waiting until you have the medical certificate of death certificate and (green certificate from the registrar for burial or cremation) before finalising any arrangements making any arrangements
• if the person has left instructions in their will or a letter about their wishes
• letting people know about the death and funeral details by organising an obituary in a newspaper or other.

More information on arranging funerals on GOV.UK

 

Frequantly asked questions
 

What happens if I miss the phone call from the medical examiner, will it delay the process of the death certificate being issued?

The medical examiner’s office wants to check if you have any concerns about the death before the death certificate is issued. If you miss a call from them they will keep trying to contact you.
 

How will the medical examiner know who to call?
The medical examiner’s office will contact the next of kin registered with the deceased’s GP/doctor.

Do I have to receive this phone call – can I opt out?
The medical examiner’s office will call, if you decide that you don’t need to talk to them for very long that is fine. The service is designed to support the next of kin.

What happens if I don’t speak English – will a translator be provided?
Yes, interpreting services will be available to support bereaved relatives who need them.

Can I call the medical examiner to speed up the process?

Yes, you can contact the office for your borough using the following details

Borough	Medical examiner service base	Medical examiner office email
Hillingdon	Hillingdon Hospital	Thh.me-community@nhs.net
Harrow, Brent, Ealing	Northwick Park Hospital	lnwh.tr-medicalexaminer@nhs.net
Kensington and Chelsea  Hounslow	West Middlesex Hospital	chelwest.bereavementteam.wmuh@nhs.net
Hammersmith and Fulham, Westminster	Imperial	Imperial.medicalexaminer@nhs.net

 

For religious reasons I need to register the death quickly?
The medical examiner’s office is sensitive to religious needs surrounding burial.  They will make sure they call next of kin as soon as possible within 24 hours of the death.

How long will it take for the medical certificate for cause of death to be issued?

The certificate is issued by the GP after the Medical Examiner review and a discussion between them. In most cases this will be within a day of the death but in some cases may be longer. If the death needs to be referred to the coroner there will be a delay in issuing the death certificate. This will vary depending on what the coroner decides they need to do.

What happens if the death is referred to the Coroner?
Coroners investigate all deaths where the cause is unknown, where there is reason to think the death may not be due to natural causes, or which need an inquiry for some other reason. The GP has a legal duty to report any death that meets the coroner’s referral criteria. The GP or medical examiner’s officer will tell you if the death of your loved one has to be referred.

The coroner will investigate each case in an appropriate way. It may be as simple as consulting with the doctor who last treated the person who has died, or a post mortem examination may be needed. 

In some cases, the coroner may open an inquest, which is a judicial inquiry into the death. Coroners have the power to have a body brought into the public mortuary and keep it there while they carry out investigations.

For further advice please visit the gov.uk website.

 

You can find out more about the medical examiner service here.

London medical examiner's offices:

Full list of contact details for medical examiner offices in England and Wales - NHS England website

Local details below:

Host trust	Lead ME	London boroughs	Office number and email
Barking, Havering & Redbridge University Hospitals NHS Trust   *King George *Queen’s	Dr Peter Tanner	Barking & Dagenham Havering Redbridge	01708 435000 ext 3307  bhrut.medicalexamineroffice@nhs.net
Barts Health NHS Trust   *St Bart’s *Newham *The Royal London *Whipps Cross	Dr William White	City of London Newham Tower Hamlets Waltham Forest	St Bartholomew’s 020 3465 6470   Newham 020 7363 8055   Royal London 07842 323392   Whipps Cross 020 8539 5522 ext. 4399 & 4398   bartshealth.bhtmedicalexaminerservice@nhs.net
Chelsea & Westminster Hospital NHS Foundation Trust   *Chelsea & Westminster *West Middlesex	Dr Sarah Cox (Chelsea)       Dr Elora Mukherjee (West Mid)	Hounslow Kensington & Chelsea	0203 315 8650 Chelsea   chelwest.medicalexaminer@nhs.net West Middlesex chelwest.bereavementteam.wmuh@nhs.net
Croydon Health Services NHS Trust   *Croydon	Mr Gregory Ward	Croydon	0208 401 3719 ch-tr.medicalexaminer@nhs.net
Epsom & St Helier University Hospitals NHS Trust   *Epsom *St Helier	Dr Sally Lewis	Sutton	020 8296 2493 esth.medex@nhs.net
Guy’s & St Thomas’ NHS Foundation Trust   *Guy’s *St Thomas’ * Royal Brompton * Harefield	Dr Luke Smith (GSTT)     Dr Sarah Trenfield (RB & H)	Lambeth Southwark	020 7185 2608 (GSTT) medicalexaminer@gstt.nhs.uk         Harefield 01895 828638   gst-tr.medicalexaminer@nhs.net     Royal Brompton 0207 352 8121 ext 82268   MedicalExaminerService@rbht.nhs.uk
Homerton University Hospital NHS Foundation Trust *Homerton	Dr Nicola Radford	Hackney	0208 510 7150 Huh-tr.medicalexaminer@nhs.net
Imperial College Healthcare NHS Trust   *Charing Cross *Hammersmith *Queen Charlotte’s & Chelsea *St Mary’s *Western Eye	Dr Susannah Long	Hammersmith & Fulham Westminster	Hammersmith 0203 313 3075    Charing Cross 0203 311 1098    St Mary's Hospital 0203 312 3325   imperial.medicalexaminer@nhs.net
King’s College Hospital NHS Foundation Trust   *Kings College *Princess Royal University Hospital	Dr Yasmin Kapadia	Bexley Bromley	020 3299 34051 kch-tr.meoffice@nhs.net
Kingston Hospital NHS Foundation Trust   *Kingston	Mr Andrew Pooley	Kingston Richmond	020 8934 3478 khft.medicalexaminers@nhs.net
Lewisham & Greenwich NHS Trust   *University Hospital Lewisham *Queen Elizabeth Hospital, Woolwich	Dr Charles Mazhude	Greenwich Lewisham	QEH 0208 836 4626 UHL 0203 192 6045 lg.medicalexaminerofficecommunitylgt@nhs.net
London NW University Healthcare NHS Trust   *Central Middlesex *Ealing * Northwick Park * St Mark’s	Dr Glynn Evans	Brent Ealing Harrow	Northwick Park And St Mark’s Hospitals   020 8869 5849 Ealing and Central Middlesex Hospitals   020 8967 5740 lnwh-tr.medicalexaminer@nhs.net
North Middlesex University Hospital NHS Trust   *North Middlesex	Dr Rebecca Gillibrand	Enfield Haringey	northmid.medicalexaminer@nhs.net
Royal Free London NHS Foundation Trust   *Barnet *Chase Farm *Royal Free	Dr Rachel Craig	Barnet	Royal Free Hospital: 020 7472 6393 rf-tr.rfmeo@nhs.net     Barnet Hospital: 020 8216 4744 rf-tr.bhmeo@nhs.net
The Royal Marsden NHS Foundation Trust   *RMH – Chelsea *RMH - Sutton	Mr Cyrus Kerawala (Fulham)     Mr Jonathan Handy (Sutton)	N/A	Chelsea 0207 808 2012   Sutton 0208 915 6778
St George’s University Hospital NHS Foundation Trust   *St George’s * Queen Mary’s Roehampton	Dr Nigel Kennea	Merton Wandsworth	0208 725 4317 Medicalexaminer@stgeorges.nhs.uk
The Hillington Hospitals NHS Foundation Trust   *Hillingdon * Mount Vernon	Dr Jeremy Weinbren	Hillingdon	01895 2793354 thh.medicalexaminer@nhs.net
University College London Hospitals NHS Foundation Trust (plus Great Ormond Street and Moorfields)   *University College Hospital   *National Hospital for Neurology and Neurosurgery   *Hospital for tropical diseases   *Royal National ENT and Dental Hospitals	Dr Sally Wilson	Camden	0203 447 5130 0203 447 5129 uclh.medicalexaminer@nhs.net       uclh.camdenme@nhs.net
Whittington Health NHS Trust *Whittington	Dr Francesca Silman	Islington	020 7288 5680 whh-tr.medicalexaminer@nhs.net