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When a person dies, one of the first steps for their representative is to obtain a death certificate. The cause of death will either be investigated by a coroner or certified by a medical practitioner. Although medical examiners, who operate independently from coroners and medical practitioners, have increasingly reviewed causes of death, this practice has not been mandatory
However, starting on 9 September 2024, new reforms will require an independent review by either a coroner or medical examiner for all deaths in England and Wales, without exception.
The following regulations set out the detail of how the reformed process will work.
In England:
The Medical Certificate of Cause of Death Regulations 2024The Medical Examiners (England) Regulations 2024The National Medical Examiner (Additional Functions) Regulations 2024
In Wales: The Medical Examiners (Wales) Regulations 2024
There is also government guidance accompanying the regulations, which explains the legal requirements in each area.
Summary of key changes
Medical examiners will review the cause of death proposed by the attending practitioner, who can complete a Medical Certificate of Cause of Death (MCCD) based on their knowledge and belief.
This simplifies the previous rules, which had required a referral to a coroner if the attending practitioner had not seen the patient within 28 days before the death or had not seen the patient in person after death.
New Medical Certificate of Cause of Death (MCCD): A revised MCCD will replace the existing certificate and will include details of the medical examiner and additional information regarding the person who has died. This will assist with local and national mortality data.Exceptional circumstances: If an attending practitioner is unavailable, the death will be referred to the senior coroner.
Should the senior coroner decide not to investigate, it will be possible for them to refer to a medical examiner to certify the death.
The coroner’s investigation process: The process remains largely unchanged. Referrals to the coroner will be made by the attending practitioner or the medical examiner, instead of the registrar.Registration of death: Once the cause of death is confirmed by the attending practitioner and the medical examiner, and the declarations of certification and scrutiny have been completed, the MCCD is sent to the registrar. This is the point at which it will be possible for the representative of the deceased (who will be notified) to arrange the registration of the death through the registry office.
New categories of informants: The deceased’s partner or representative will be formally allowed to register the death, expanding the categories of informants.Changes for cremation processes: The scrutiny previously conducted by a medical referee before a cremation will be transferred to the medical examiner, eliminating the need for an additional review by a medical referee.
Impact of the changes
It is an important and welcome change that all causes of death will be scrutinised by a medical examiner or coroner. The following matters may also impact on those involved in services for the deceased and their representatives.
Increased timescales for registering a death: It may take longer for deaths to be certified and registered due to the need for a medical examiner to complete an MCCD and for this to be sent to the registrar. This may be the case particularly in the initial months from September 2024, whilst the process beds in.Notification of deceased’s representative: The deceased’s representative will be contacted to confirm the MCCD has been sent to the registrar and that they can now register the death.Changes to death certificates: New death certificates will include some different information, such as the new categories of informant (deceased’s partner, and deceased’s representative).Greater efficiency in coroner cases: Over time, the involvement of medical examiners should streamline cases requiring coroner intervention.Improved mortality data quality: Enhanced scrutiny and additional data collection will benefit national statistics.