Following recommendations from a number of key inquiries ( Dr Harold Shipman, Mid Staffordshire Hospitals) a new National Service, the Medical Examiner Service (https://www.england.nhs.uk/establishing-medical-examiner-system-nhs/) is being rolled-out across England and Wales to provide greater scrutiny of deaths. The system also offers a point of contact for bereaved families to raise concerns about the care provided prior to the death of a loved one. Acute Hospital Trusts have been asked to host the offices but the Medical Examiners (MEs) are independent of them with a separate professional line of accountability to regional and national teams.
Medical examiners are part of a national network of specifically trained independent senior doctors (from any specialty). Overseen by a National Medical Examiner, they scrutinise all deaths that do not fall under the coroner’s jurisdiction across a local area.
Currently the system is non-statutory but as outlined in The Health and Care White Paper (https://www.gov.uk/government/speeches/the-future-of-health-and-care) the plan is for the medical examiner system to become statutory but It is anticipated that the non-statutory medical examiner system will continue throughout the 2021/22 financial year whilst parliamentary procedure is followed.
The initial roll out, during the financial year 20/21, was across acute trusts and in this next financial year it is to be extended to cover primary care, community hospitals and hospices, with the objective of achieving scrutiny of all non-coronial deaths by the end of the financial year.
The purpose of the medical examiner system is to:
•provide greater safeguards for the public by ensuring proper scrutiny of all non-coronial deaths
•ensure the appropriate direction of deaths to the coroner
•provide a better service for the bereaved and an opportunity for them to raise any concerns to a doctor not involved in the care of the deceased
•improve the quality of death certification
•improve the quality of mortality data.
The process requires the ME offices to be notified of any death, the attending doctor is then contacted to provide a clinical summary and a proposed cause of death. The ME service then provides independent scrutiny, contacts the attending doctor to agree the Medical certificate of Cause of Death (MCCD) or next steps. The attending doctor completes the MCCD and cremation forms and the ME contacts the bereaved family to explain the MCCD and to give them the opportunity to ask questions and raise any concerns.
The roll out of the service to the Community Hospitals and the Hospices is planned for April 2021 and we have two pilot GP practices signed up, the Canterbury Medical Practice and the Heron Medical Practice. Once we have ensured that the process works effectively for all parties we will be rolling the service out across East Kent from the beginning of Quarter 2 (July 2021) with a plan to have full coverage by the end of the financial year.
If you have any questions or are interested in becoming a medical examiner or in your practice being in the first wave then please contact me at email@example.com
Dr Michelle Webb, Renal Consultant EKHUFT and Lead Medical Examiner East Kent.