By Jenny Collins, Lead Medical Examiner Officer for MFT
Medical examiner offices at acute trusts now provide independent scrutiny of non-coronial deaths occurring in acute hospitals. The role of these offices is being extended to also cover deaths occurring in the community.
Medical examiner offices are led by medical examiners, senior doctors from a range of specialties including general practice, who provide independent scrutiny of deaths not taken at the outset for coroner investigation. They put the bereaved at the centre of processes after the death of a patient, by giving families and next of kin an opportunity to ask questions and raise concerns. Medical examiners carry out a proportionate review of medical records and liaise with doctors completing the Medical Certificate of Cause of Death (MCCD).
What medical examiners do?
Medical examiners’ conclusions can inform learning to improve care for future patients, or, in a smaller number of cases, may be referred to others for further review. Their involvement also provides reassurance to the bereaved.
Medical examiners seek to answer three questions:
- What caused the death of the deceased?
- Does the coroner need to be notified of the death?
- Was the care before death appropriate?
Medical examiners answer these by providing independent scrutiny, with three elements:
- A proportionate review of relevant medical records
- Interaction with the doctor completing the Medical Certificate of Cause of Death
- Interaction with the bereaved, providing an opportunity to ask questions and to raise concerns
How medical examiners can benefit primary care
Medical examiners are already delivering benefits outlined in the National Medical Examiner’s 2020 report, including fewer rejected MCCDs, improved referrals to coroners, improvements to patient care, and positive feedback from certifying doctors and bereaved people. Potential benefits for GPs include:
Supporting the bereaved:
- Introduces rigour of independent scrutiny, reassures the bereaved/relatives of deceased patients
- This does not replace GPs speaking with families or next of kin, providing the support they wish to give.
Support with MCCD completion:
- Support in drafting MCCDs (and developmental opportunity to grow skills) and fewer MCCDs rejected by registrars
Supporting work with coroners’ offices:
- Medical examiners are a source of medical advice for coroners, which should reduce requests from coroners for GPs to discuss cases or to advise on wording.
- Support with notifications to the coroner.
- Medical examiners will support the doctor completing the MCCD, drawing on their extensive knowledge gained through training and regular exposure to more complex scenarios to support and advise.
Urgent release of the body:
- Medical examiners have developed positive relationships within faith communities, and will be able to support in the urgent issue of the MCCD.
Concerns and learning:
- A key objective for the medical examiner system is to identify constructive learning to improve care for patients.
- Respectful and non-judgmental but independent scrutiny – identifying areas for improving care for patients and for further review
The National Medical Examiner recognises the complexity of extending the medical examiner system to primary care and advises that implementation should proceed carefully and through an agreed incremental process made possible by this non-statutory period.
The National Medical Examiner’s service will begin its statutory phase in April 2023
What do GPs need to do?
The Royal College of Pathologists has now trained more than 1,200 medical examiners; and the National Medical Examiner’s office has established the legal basis for providers to share records of deceased patients for medical examiner scrutiny.
Medical examiner offices have the ability to make their plans and put processes in place to suit local conditions as such discussions are currently underway between the MFT ME service, the CCGs and LCOs.
At this time there is nothing GPs need to do, the Medical Examiner’s Service team at MFT will circulate further information in due course and keep you updated in a timely manner of any implementation steps.
In the interim if you have any questions or would like further information on the Medical Examiner’s service covered by MFT please get in touch:
Jenny Collins, Lead Medical Examiner Officer for MFT
Telephone number: 0161 2913266