Myth buster time. There was an erroneous ‘rumour’ that GPs could only complete an MCCD if they had seen the deceased in person anytime during their lifetime.
After some digging, I found that this had come from the Regional Medical Examiner and not from anyone locally. I wrote to him pointing out the following:
- There is no change in the legislation, and none of the pertinent regulations require that the attending practitioner has viewed the deceased in person prior to death.
- The government Guidance for medical practitioners completing medical certificates of cause of death in England and Wales (last updated 4 December 2024) includes a section on what is ‘generally accepted’ as the definition of ‘attended’ and this does not include that the deceased has been viewed in person prior to death.
- The change in position would result in an increase in referrals to the coronial service for patients whose death has been expected and natural, which is out with Guidance No 47 issued by The Chief Coroner.
- In other parts of the East Midlands the revised guidance was considered, rejected and the local practitioners continue to follow the legal requirements and government guidance.
- The legal responsibility and liability for ensuring that an MCCD has been correctly completed, including the identity, fact of death, and cause of death lies with the attending practitioner. It would seem appropriate to consider that these professionals will act professionally.
- That the suggested change is nonsensical. For example: Patient One: I perform a 6-week baby check on this patient who develops and dies of a brain tumour in their twenties and during this illness I have one conversation with a relative and nurse and sign a couple of scripts. Patient Two: An elderly patient is discharged as end of life to live with a relative who is a registered patient of our practice and dies a couple of months later, during which time I have multiple telephone conversations with the patient, relatives, palliative care nurses and with the patient have formulated a ReSPECT form with Advanced Care Plan and provide anticipatory medication, and then verify the patient after death. From your guidance I can complete a MCCD for Patient One but not for Patient Two?
We have also received confirmation from the national Medical Examiner that there is no requirement to have seen the deceased during life to complete an MCCD.
I understand that for a short while the ME service was advising GPs that this was a requirement, which led to inappropriately and unneeded coronial referrals. I apologise for any confusion, but we are now back to business as usual.
Please contact the LMC if you have any questions about this.