Understanding the Role of Medical Examiners in Death Certification Process

Note: the certifying doctor must have seen the patient in their lifetime either by face to face or video consultation and know to the best of their knowledge or belief the medical cause of death. Please ensure that referrals are filled out as completely and correctly as possible, this reduces time spent trying to source the additional information from the practice. Please don t deduct the deceased from EMIS until death certification is completed as once deducted SMES are unable to view the patient record. Somerset Medical Examiner Service (SMES) If you have any questions or would like further information on SMES, training on certification of death or reporting to HM Coroner, please contact: MedicalExaminer@somersetft.nhs.uk Frequently Asked Questions General Practice Or call 01823 344995 July 2024 Version 4

What happens if a coronial referral is required after ME review? What is a Medical Examiner? If, following the review of a patient's case, the ME identifies a reason why a coronial referral is required, we will contact you 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. 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: What do we tell NOK? reviewing the medical records. 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. liaising with the doctor who treated the patient in their final illness. If families are concerned about the 5 day rule for registration, reassure them that the 5 days begins once the certificate is sent to registrations therefore no need to worry if there is a delay in completion. agreeing the proposed cause of death with the attending doctor and the overall accuracy of the medical certificate cause of death (MCCD). Please note the SMES will not inform families of timescales of when paperwork will be completed discussing the proposed cause of death with the next of kin, ensuring they understand any medical terms and providing an opportunity for them to raise any concerns, comments or compliments that they may have. 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 Governance contact for the practice for their review. acting as a medical advice resource for the local coroner. ensuring any concerns about the care of the patient are acted on appropriately (and if possible that any compliments are relayed to the relevant person[s]). 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.

What are the aims of the Medical Examiner System? What happens once the referral is made? The stated aims of the Medical Examiner System are summarised below: 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. To provide greater safeguards for the public by ensuring proper scrutiny of all non-coronial deaths. To ensure the appropriate direction of deaths to the coroner. 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. To 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. Once these steps has 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 with the agreed cause of death. The ME2 form can be saved on the patients record. To improve the quality of death certification. To improve the quality of mortality data. Once the MCCD is completed, instead of scanning and sending to Somerset Registrations, it should be sent to SMES instead, along with the CN1A from the coroner if one has been issued. We will check it for completeness and then the ME will countersign to state that the cause of death matches that agreed during scrutiny. We will then forward to Somerset Registrations.

How do I refer to SMES? Who are the Medical Examiner Officers? 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. 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. 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. 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. We will review the case as soon as possible however, if there is an urgency e.g. the doctor is going on annual leave, the patient's faith dictates things are done quickly, please call us to let us know or include it in the referral email. We will do our best to prioritise. Where are the Medical Examiner Offices? What if the patient has died of a condition which is reportable to the coroner? Medical Examiner Offices in Somerset are hosted by Musgrove Park Hospital and Yeovil District Hospital. The service is however independent from the hospital Trust. 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. 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 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. Direct line telephone number: 01823 344995