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Death Processes and The Medical Examiner Service from 9 September 2024

Updated on Friday 6 September 2024, 861 views

Practice Guides

Somerset Medical Examiner Service (SMES)

The statutory implementation of the Medical Examiner System is approaching and will impact all Somerset GP practices by September 2024, (under legislation in the 2022 Health and Care Act). Nationally there has been an official change to the statutory implementation date, which was April 2023. The new statutory date for compliance by all practices will be September 9th 2024.

Despite this delay  some Somerset practices are using the new referral pathway and referring deaths through the Somerset Medical Examiner Service (SMES). We will continue to encourage all practices that are not yet set-up, to do so as soon as possible, to receive the support and advice of SMES.

The change means that from  September 2024 all deaths in the community (except definitive coronial cases eg sudden unexpected deaths) will need to be referred to SMES before a Medical Certificate of Cause of Death (MCCD) can be provided. Referral to SMES will be through EMIS. The process should not cause undue delays for the bereaved and the final certificate will continue to be sent electronically to the registrar.  For the public they will not need to do anything differently.

For further information on the implementation process please click here

What is a Medical Examiner?

Medical Examiners (ME) are senior medical doctors, who are trained in the legal and clinical elements of death certification processes.

The role of the medical examiner includes:

Aims of the Medical Examiner System

The stated aims of the Medical Examiner System are summarised below:

For information on the referral process please see Frequently Asked Questions

Access to medical records

Medical examiners will have a statutory right of access to the records for the purposes of their role. The current position is that whilst the legislation is updated, to ensure information governance and data protection requirements are fulfilled, for the period before the statutory system commences, NHS England submitted an application under Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 (‘section 251 support’) to process confidential information without consent.

The approved application (which has been extended until 31 March 2024) can be found on the Health Research Authority (HRA)’s website (ref: 21/CAG/0032). The HRA’s Confidentiality Approval Group approval covers the sharing of medical records of deceased patients or the equivalent access to view those records with both medical examiners and medical examiner officers. It is expected that medical examiners will be added to the list of persons with a right of access to patient records in the Access to Health Records Act (1990) when the Medical Examiner System moves onto a statutory footing.

Frequently asked questions 

Who are the Medical Examiner Officers?

Medical Examiner Officers (MEOs) are a team of staff who are specifically trained by the Royal College of Pathologists. They come from varying backgrounds and will be involved in all stages of the ME service, talking to the attending doctors, liaising with GP practices and speaking to the bereaved about the wording on an MCCD.

MEOs can provide advice and support on the SMES process and the completion of the MCCD/cremation papers as necessary. MEOs provide the continuity and oversight that the service requires to have the maximum benefit.

Where are the Medical Examiner Offices?

Medical Examiner Offices in Somerset are hosted by Musgrove Park Hospital and Yeovil District Hospital. The service is however independent from the hospital Trust.

The main hub where referrals are collated is Musgrove Park Hospital. Opening hours are 8am until 5pm. Please contact us if you have any questions or require further information about the service.

The generic email address for the service is: MedicalExaminer@SomersetFT.nhs.uk

Direct line telephone number: 01823 344995

How do I refer to SMES?

Referring to SMES is by way of completion of a brief, standardised referral form and emailing it to the SMES generic email address. It can be completed by the GP or a member of the administrative team delegated by the GP.

The SMES referral template is now available on the EMIS eTemplates site and is titled: Somerset Medical Examiner Service Referral Form. If you are unsure if you have the correct form, please email us and we can check what you have is the correct one.

We cannot guarantee that case will be reviewed if it has been sent after 15.30 however if there is an urgency e.g. the GP is going on annual leave, the patient's faith dictates things are done quickly, please call us to let us know or include this information in the referral email. We will do our best to prioritise.

Workflows have been created for practice staff to refer to on the referral processes, see the Useful Documents.

What if the patient has died of a condition which is reportable to the coroner?

If the Cause of Death is known but is reportable to HM Coroner (HMC) the GP can complete the Coroner Electronic Death Reporting Form (EDRF) and send it to SMES instead of the SMES referral form. This will cut down on the number of different forms they need to complete. Once reviewed by an ME, SMES will then forward the EDRF to the Coroner’s office and copy in the GP practice, so you know it has been sent.

If the GP is unsure if the death is reportable, they can call the ME Office to discuss prior to completing any forms.

If the patient has an unknown cause of death, SMES does not need to know about these patients and the GP can send a coronial referral directly to the coroner’s office.

What happens once the referral is made?

Following receipt of a referral, the ME will review the patients record and form an opinion on the cause of death. If that opinion is different to that of the GP, SMES will email the practice to ask for the GP to contact the ME on our direct number when they are able so that the cause of death can be discussed further.

When the cause of death is agreed, the ME/MEO will contact the patients next of kin to discuss the care the patient has received and cause of death.

Once these steps have been completed, SMES will send an ‘ME2’ form back to the practice which will state that the case has been reviewed by the duty ME, that it has been discussed with the next of kin and the cause of death agreed. The GP can now go ahead and complete the MCCD +/- cremation papers with the agreed cause of death. The ME2 form can be saved on the patients record.

Once the MCCD is completed, instead of scanning and sending to Somerset Registrations, it should be sent to SMES instead, along with the Part A from the coroner if one has been issued. We can check that it has been completed fully and then we will forward to Somerset Registrations.

What happens if a coronial referral is required after ME review?

If, following the review of a patient’s case, the ME identifies a reason why a coronial referral is required, we will contact the practice to inform you. We are unable to complete the coronial referrals on behalf of doctors however if there is a query as to whether the patient falls under the jurisdictions of the coroner prior to the referral being made, please call the office to discuss first.

What do we tell NOK?

Please let families know that they will receive a routine phone call from the ME office.

The medical examiner office will be able to:

Keep the family informed as you normally would. It is important to manage families’ expectations and to aid that we have produced a short leaflet that can be given to families following a death. To access this leaflet, please see the Useful Documents section.

If families are concerned about the ‘5 day’ rule, which is what the Registration services go by, reassure them that if the paperwork takes more than 5 days to be completed, nothing will happen, and that Registration Services will know by the date the MCCD is completed that there was a delay with the completion of the paperwork.

Please note the SMES will not inform families of timescales of when paperwork will be completed.

What happens if concerns are raised?

If concerns are identified as part of the ME review, or by the family raising them with the ME team which require highlighting to a practice, a Clinical Governance form will be completed with the concerns detailed which will be sent to the practice for their review.

As part of the ME process, there is also a responsibility to inform other agencies depending on certain circumstances. This is as a result of the national Learning from Deaths guidance. Some of the circumstances which require escalation to different agencies include; the death of a patient with learning disabilities, safeguarding concerns, deaths where the bereaved or staff raise concerns about the medical care or communication processes.

Somerset Medical Examiner Service

Email - MedicalExaminer@somersetft.nhs.uk

Tel. Number – 01823 344995

Somerset Medical Examiners

Dr Richard Innes

Miss Yee Leung

Dr Peter Campbell (Lead)

Dr Dave Lee

Dr Mala Pradeep

Dr Paul Lambert

Dr Jason Louis

Dr Matthew Hayman

Dr Martin Newbury

Dr William Tuff

Dr Rebecca Browning

Dr Bozena Lassota-Korba

Dr Caroline Dailley

Dr Nick Craw

Dr Martha Manning

Dr Phil Raines

Dr Mike Gailey

Dr Jo Kerr

Dr Nicola Johnson

 

SMES Implementation Lead

email - helen.waldon@somersetft.nhs.uk

mobile 07741 693 636

HM Coroner’s Office for Somerset

Email Officers - CoronersOfficersSomerset@avonandsomerset.police.uk

Email HM Coroner - Coroner@somerset.gov.uk

Somerset Registrations

Email - SomersetRegistrations@somerset.gov.uk

Tel. Number – 01823 282 251

Other resources

NHS England » The national medical examiner system

The role of medical examiners (rcpath.org)

Guidance for doctors completing medical certificates of cause of death in England and Wales (publishing.service.gov.uk)

Guidance for registered medical practitioners on the Notification of Deaths Regulations (publishing.service.gov.uk)

Register a death (somerset.gov.uk)

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