NEW: Medical examiner process

The statutory rollout of the medical examiner system 

The statutory implementation of medical examiner system is now live.
This came into practice on 9 September 2024 (under legislation in the 2022 Health and Care Act). 

The legislation means that independent scrutiny by a medical examiner is now a statutory requirement prior to the registration of all non-coronial deaths in England and Wales. Information from the Department of Health and Social Care is here

This new process requires practices being set-up on SystmOne and EMIS

Practices should now be set up with the new IT system and referring deaths through the medical examiner’s office.
If you need help - please contact the IT team.

On this page (in the drop downs below) you will find:

  • Training guides to get your practice setup on SystmOne/EMIS
  • Frequently asked questions for practice staff
  • Guidance for completing the Medical Certificate of Cause of Death MCCD
  • Information for the public
  • Contact details
Quick overview - What does this mean for GP practices?  
  • The change means that all deaths in the community (except clear coroner referrals) need to be referred to the medical examiner office before a death certificate can be provided. Referral to the medical examiner will be through SystemOne/EMIS.
  • From the date of statute, the MCCD must be sent to the Registrar office by the Medical Examiner’s office.  The completed MCCD must therefore be sent to the ME office by the GP, and not direct to the Registrar office
  • The MCCD will be signed by the Medical Examiner before it is then sent to the Registrar. 
  • As part of the process the medical examiner will speak to the bereaved and talk through any questions they have.
  • The process should not cause undue delays for the bereaved and they will not need to do anything differently.

More information is also available in these two national podcasts: GPs and medical examiners working together and changes to the death certification process and introduction of the statutory medical examiner system. 

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;

 

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

 

 

 

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