Medical Examiner

Introduction

The medical examiner system is the biggest change to death certification in 150 years, and has come about as a result of the public enquiries which followed several high-profile healthcare stories. Initially, acute trusts were asked to set up medical examiner offices to focus on certification of all deaths that occurred within their own organisation on a non-statutory basis. A white paper was published in February 2021 (Working together to improve health and social care) which includes provision for MEs to be put on a statutory footing. The role of these offices is being extended incrementally during 2021/22 to include all non-coronial deaths wherever they occur.

The purpose of the medical examiner system is to Improve care for future patients by informing learning, or, in fewer cases, being referred for further review. By putting the bereaved at the centre of the process and giving them the opportunity to ask questions or raise concerns, they feel involved and this provides reassurance.

There are three questions the ME seeks to answer:

• What caused the death of the deceased?
• Does the coroner need to be informed?
• Was the care before death appropriate?

Independent scrutiny by MEs with the following three elements provides the answers:

• A proportionate review of medical records.
• Interaction with the doctor completing the MCCD.
• Discussion with the bereaved.

Medical examiner office

Medical examiners are senior medical doctors from a diverse range of backgrounds and specialities. They are contracted for a number of sessions per week as Medical Examiners, outside of their normal clinical duties.

Medical examiner officers are either Band 5 (non-clinical) or Band 6 (usually clinical, e.g. from a nursing or Paramedic background). They are the constant in the ME office and are there to facilitate the gathering of information for the MEs, and to act under delegated authority with various activities such as discussions with the bereaved.

Moving forward

During 2021/22, the Medical examiner system in Barnsley will be one of the first to expand into community deaths in preparation for the system becoming statutory. We are working on this incrementally and will be contacting PCNs and GP surgeries throughout the next few months to present our plans and discuss the best way forward. We are hoping that by developing the process with GP involvement, we will be able to make the service as beneficial as possible to all parties involved.

How the ME system can benefit primary care.

Supporting the bereaved: This will not replace GPs providing contact and support to bereaved families, but may lessen the workload by dealing with enquiries.

Support with MCCD completion: Medical examiners can use their experience and specialist training to support GPs, particularly in complex cases and decisions on coroner referrals.

Supporting local coroners’ offices: MEs can be used as a source of medical advice, which should lessen the need for GP discussions with coroners. Some ME offices will complete the coroner referral.

Clinical governance: The aim of medical examiners is not to find fault or investigate in any way, however when issues are detected, they will offer non-judgmental feedback.

Learning and concerns: Constructive learning to improve patient care is one of the key objectives of the medical examiner system.

Feedback so far:

Reports back from the Coroner and Registrar have been positive, with the Coroner stating that referrals have been appropriate and more accurate, and Registrars reporting that far fewer MCCDs are rejected since the introduction of the ME service in Barnsley.

If you have any further comments or questions, please don’t hesitate to contact us at: Barnsley.medicalexaminersservice@nhs.net.

In this video, two GPs discuss their experience of the medical examiner system. For more information about medical examiners, please go to the National Medical Examiner’s webpage and information for GPs , or email nme@nhs.net

Accessing the service

• Email: Barnsley.medicalexaminersservice@nhs.net