The National Medical Examiner (ME) system, which began in acute hospitals, has now been fully rolled out across England to include all non-coronial deaths in the community, including those certified by GPs.
Purpose of the Medical Examiner System
The ME system provides independent scrutiny of all deaths not referred to the Coroner. It is designed to:
- Ensure a consistent and transparent approach to death certification
- Offer bereaved families the opportunity to raise any concerns
- Improve the accuracy of Medical Certificates of Cause of Death (MCCDs)
- Support learning and improve the quality of national mortality data
What GPs Need to Know
All non-coronial deaths in the community now require scrutiny by a Medical Examiner (ME) before the MCCD can be finalised. The standard process includes:
- The GP completes the MCCD and provides contextual clinical information
- The ME reviews the case and proposed cause of death
- The ME contacts the next of kin (or other informant) to check for concerns
- The ME confirms agreement and clearance to proceed with registration
A direct verbal discussion between GP and ME is not required in most cases, though may occur if clarification is needed.
Use of Clinical System Templates
Most local ME offices now request or recommend the use of dedicated templates within clinical systems (e.g. EMIS, SystmOne) to support efficient and standardised reporting. These templates usually include:
- Clinical summary: explanation of the cause and circumstances of death
- Next of kin or informant details: including contact information
- Administrative details: such as whether the death was expected, intended method of disposal (cremation or burial, if known), and current location of the body
- Recent care history: including last clinical contact and involvement of other services
Practices should ensure that all relevant fields are completed before submission to the ME office, and that staff are familiar with how to access and use the template.
Key Reminders
While the official guidance is that the MCCD should not be issued until Medical Examiner scrutiny is complete, in practice some ME offices request that GPs complete and submit the MCCD in advance to speed up the process. This can occasionally lead to suggested changes and the need to reissue the certificate — frustrating, but generally not a major workload.
Use the clinical system template (where available) to ensure all necessary information — clinical and administrative — is included in your submission.
Engage promptly with any follow-up requests from the ME office to minimise delays for bereaved families.
Remember that ME scrutiny is intended to be supportive, to improve quality and safety, not to criticise or second-guess routine clinical practice.
Fees and Funding
As of September 2024, the previous cremation form fees (Forms 4 and 5) have been abolished. The ME system is now centrally funded and free of charge to families, including for cremations.
Further Support
- Contact your local ME office for process-specific questions or guidance
- National updates and advocacy are provided by the BMA and RCGP