GPC England have sent updated information regarding the statutory rollout of the Community Medical Examiner programme.

“Colleagues will recall the ultimately postponed March 2023 introduction of the Medical Examiner (ME) scrutiny of non-coronial deaths in the community; this is now planned to be implemented in April 2024.

Regrettably there is no consistency within the England wide rollout; instead, ME units have been asked to form geographically appropriate links with local GP practices; this then means each practice should know where the deceased’s details, including medical records and the proposed MCCD (Medical Certificate of Cause of Death), should be sent. If a GP wishes to report a death to the coroner instead, they can still do so but increasingly it is likely the coroner’s office may ask if this referral has been discussed with the medical examiner first.

The purpose of the ME scrutiny is to:

• review the proposed cause of death on the MCCD
• review the care offered to the deceased prior to their death
• to offer an opportunity for the bereaved to ask any questions about, or put forward any concerns in relation to, the deceased’s care.

The ME can contact the GP who has written the proposed MCCD to discuss this, or any information in the medical records. If all goes smoothly, the ME will confirm the proposed MCCD with the Registrar, GP practice, and a person who can act as the informant in terms of registering the death – normally a family member of the deceased.

The ‘attending practitioner’ will remain responsible for completing the MCCD, although there is now provision for a GP not being available, as in exceptional circumstances the ME can write a MCCD. If the ME and attending GP cannot agree on the cause of death, the matter will be referred to the Coroner.

To complement the ME arrangements, a new paper MCCD will be available from April 2024, with an online version promised later this year. This will include:

• details of the ME who scrutinized the cause of death
• ethnicity, if this is recorded in the deceased medical records
• medical devices and implants to be recorded on the MCCD by the attending practitioner.

The current Crematorium Form 4, and the private fee payable, is being abolished. Based on feedback so far, GPC England has the following concerns:

• the provision of information to ME Units from practices may be administratively burdensome in some cases
• ME units may not have sufficient capacity to undertake the scrutiny of community deaths within reasonable timescales and be unable to adapt these timescales to faith groups with particular expectations
• ME units may not appreciate the level of patient concerns and distress about delays in this process, as these concerns are currently being directed to practices.

GPC England recommends LMCs ask all practices to confirm their links with local ME units and to test the system for reliability and administrative burden. GPC England has written to the National Medical Examiner to highlight these continuing concerns.”

Lincolnshire LMC understands that the Lincolnshire Community Medical Examiner service is still keen for practices to sign up and pilot the service prior to April 2024 as this may solve any teething issues for the practice and help the CME service to avoid large numbers of GP practices switching to the service on mass in April. Any practices wishing to pilot the service now should contact the CME service at licb.medicalexaminers@nhs.net

The LMC is working with the ICB and Arden & Gem to explore SystmOnline Hub modules for both CME service and safeguarding team so that access is granted to those services only regarding the relevant patients. This will support proportion access to records that helps minimise risks to practices as the data controllers rather than full access to the entire patient list being granted.