Revamp of regulations to certify cause of death

As the new death certification regulations come into force, Medicolegal Consultant Dr Emma Davies looks at the implications for general practice staff.

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Changes to the way that causes of death are certified came into force on 9 September this year.

The new regulations, titled The Medical Certificate of Cause of Death Regulations 2024, set out the legal requirement for all deaths to be subject to scrutiny by either a medical examiner or a coroner’s investigation.

The requirements to refer to the coroner are unchanged and are outlined clearly in regulation 2 of the Notification of Deaths Regulations 2019. Therefore, all deaths that are not referred to a coroner must be referred to a medical examiner service.

All registered medical practitioners are encouraged to read the new regulations to ensure they fully understand their duties.

The 2024 amendments include changes to the definition of attending physician – the criteria setting out who is eligible to complete a medical certificate of confirmation of death (MCCD). Patients will no longer need to have been seen either within the last 28 days of life or seen after death, as long as the doctor has at some point seen the deceased in life for any illness.

Review relevant records

This means it should be easier for practices to find an attending physician to complete the MCCD. However, the attending physician must ensure they review all the relevant medical records, and any other information available to them, to ascertain the cause of death to the best of their knowledge.

Once the attending physician has come to a conclusion on their view of the cause of death, they must refer the case to a medical examiner. The medical examiner is, by law, entitled to all information they deem to be relevant to the cause of death.

Once a case has been referred the medical examiner will review the case, come to their conclusion on the cause of death and speak with the family. In cases where the proposed cause of death accords with the medical examiner’s findings and the family has not raised any concerns which would require referral to a coroner, the medical examiner will then notify the registrar of the completed process.

On those occasions where the medical examiner feels a discussion with the attending physician is going to be helpful, the attending physician must ensure they are accessible to the medical examiner.

The new legislation will come with new MCCD certificates, and examples of these are available on the government website. It is anticipated these forms will be electronic.

Over the next few months there will be communication with further detail on the nature of the changes, alongside some operational guidance. It is going to be essential that practices look out for this information and engage with the changes needed, to ensure they are up to date and compliant with the new legal requirements.