The implementation of a new system requiring GPs to agree death certificates with a medical examiner has been postponed to September, the Department of Health and Social Care (DHSC) has confirmed.
The DHSC has today laid regulations in Parliament which will put the medical examiner system on a statutory footing from 9 September, following multiple delays.
This also means that changes to simplify the death certification process for GPs, such as the cremation form becoming redundant, will not come into force until September.
Pulse understands that GPs in some areas are already using the system, which sees medical examiners (MEs) providing independent scrutiny of all deaths in the community not taken to the coroner, but the necessary legislation has been repeatedly postponed.
As recently as last month, there were concerns around the implementation of the system, which seemed unlikely to launch at the beginning of April as planned.
Now the Government has confirmed an official September start date, emphasising that the death certification reforms are ‘highly complex and sensitive’, and that it has ‘allowed additional time to prepare for implementation’.
The system has been developed in part as a response to the GP Harold Shipman’s murder of his patients, and the Lucy Letby case, which both ‘highlighted the need for an extra layer of scrutiny’.
From 9 September, any GP who has ‘attended the deceased in their lifetime’ will be eligible to be an attending practitioner, which simplifies the current requirements whereby GPs or clinicians are only eligible if they have attended the patient during their last illness.
The process means GPs have to give access to a deceased patient’s records in order for the ME to reach agreement on the accuracy of the medical certificate of cause of death (MCCD), where before this extra scrutiny was not required.
The statutory system was formally introduced by the Health and Care Act in 2022 and NHS England wrote to GP practices in England in July last year asking them to implement processes to facilitate the work of medical examiners by 31 March 2023.
In December, DHSC said GP practices should ensure they make ‘the necessary arrangements’ to share records of deceased patients, recommending these processes are set up ‘with immediate effect’.
Currently, for non-coronial deaths, GPs must complete a form if patients are to be cremated, however the new statutory system will make this form ‘obsolete’ since information about medical devices and implants in the body must be included as part of the medical certificate of cause of death (MCCD).
Today, health minister Maria Caulfield said the new measures will make the system ‘safer by improving protections against rare abuses’ and will ensure the bereaved are kept ‘fully informed’.
‘Reforming death certification is a highly complex and sensitive process, so it was important for us to make sure we got these changes right,’ she added.
In Parliament, the minister said: ‘This is the most significant set of reforms to death certification in 70 years and we have allowed additional time to prepare for implementation.
‘We are working closely with our partners in Government, local registration services, coronial services and the health service to ensure that the appropriate operational processes are in place to deliver these changes in September 2024.
‘There will be further communication regarding legislative changes and operational guidance between now and September 2024.’
Dr Suzy Lishman, senior advisor on medical examiners for the Royal College of Pathologists, which is the lead college for MEs, said doctors in this role are ‘already scrutinising the majority of deaths’ in England and Wales.
‘The move to a statutory system in September will further strengthen those safeguards, ensuring that all deaths are reviewed and that the voices of all bereaved people are heard,’ she added.
Earlier this year, the BMA warned that the new medical examiner system will be ‘administratively burdensome’ for GP practices, and that some MEs may not have capacity to provide scrutiny for community deaths within ‘reasonable timescales’.
翻译：
Good news it is being delayed, better still if it were to be scrapped
Unnecessary and unwelcome administrative burden to us and extra stress and hassle to patients.
Whoever dreamt this up does not work at the coal face of general practice.
The examiners we have had to deal with to date are wholeheartedly incompetent and insensitive. Time-consuming ineffective work helping others set up a poorly planned doomed system. It’s like we are being led by idiots.
Well I may be a lone voice here but we are trialling this locally and I think it’s fine.
Downsides: extra delay for family, GP has to email the med examiner
Upsides: no certs being rejected EG by registrar for sensible or non-sensible reasons. You get confirmation that your cert will be acceptable BEFORE writing it.
If you couple that with no crem form and any GP who has ever seen pt able to issue cert (without a pointless trip to “view the body”) this comes out as a net positive change for me.
As Dylan says, this has the possibility of being a positive change.
But the chaotic rollout does not give much hope.
My prediction is that within a few months, especially in Winter, the ME system will see massive delays in issuing death certs as examiners struggle to keep up with the deluge, and grieving relatives will bombard us with (justifiable) angry complaints..
Surely it would have been more sensible to allow the death cert to be filled in FIRST, then sent to the ME for confirmation before being approved., with explanatory notes entered into the shared patient records rather than filling in yet another damned time-sucking form.
Trick missed; get the medical Examiner to fill out all Death certificates and cremation red tape. Free up G.P. time to deal with the living[and the dying].
Phil
What a pointless waste of time and effort – made worse by the fact that DHSC couldn’t organise a piss up in brewery
Sure, they would make you go to the brewery, which would be 200 miles away. They would make you bring your own beer glasses and a written risk assessment and proof that you have a nominated driver to get you home and current Hep B status. But the beer hops would not have even been planted and the premises would not have a licence or any staff, and it wound not actually be a brewery…
So are Crem fees to be scrapped? or would ME get these?
What about deaths at home? Do medical examiners have to attend in person?
Imagine the delays in that case…
Or can the GP complete certificate or any GMC registered doctor if they have known and cared for deceased in life?
Very unclear about who/how many doctors must see body before certification.
Somebody mentioned before, the GP wouldn’t have to see the body before completing certificate. In which case it’s down to the ME to do so? In which case, imagine the workload if they cover a Lincolnshire area for example.. And the frustration of the deceased family….