MEDICAL EXAMINER SERVICE UPDATE – January 2025

UPDATE BY DR GRANT INGRAMS, LLR LMC CHIEF EXECUTIVE OFFICER

The LMC have been consulting with the ME service, coroners, registrar service, and funeral directors about feedback following the change in the death processes from September 2024.

Just as a reminder this is a statutory process that was forced onto the profession with no consultation. The project was a complete dog’s dinner from start to finish and indeed has still not been completed (for example the promised electronic MCCD which I was involved in the first version over 2 years ago is still not live). So, we are stuck with it and all we can do is to try and help the system run smoothly.

As hard as we worked to try and provide guidance in advance, the situation was changing up until the very last moment. Indeed, on the go-live day (9 September 2024) the Chief Coroner issued Guidance No 47, which included the hitherto unmentioned nugget that ALL natural deaths must be referred to the ME service even if there clearly was no identifiable cause of death. This also came as a complete surprise to the ME Service.

As predicted in advance, the ME service is causing delays to registration of deaths and creating unfunded additional workload for GPs.

Due to not fully understanding the different challenges there would be on taking on all community deaths (despite warnings from myself and others) the ME service was ill-prepared leading to unacceptable delays currently running at about 2 weeks.

Although GPs are getting this right most times, GPs can do their part to minimise delays and distress for the relatives and loved ones of our deceased patients. I have been told about the following:

  • Old MCCDs being completed and sent to registrar (please check and if you still have your old MCCD book – SHRED ANY UNUSED OLD MCCD CERTIFICATES).
  • Address on MCCD being given as ‘home’ rather than actual address (mistake not picked up by ME service).
  • Qualification on MCCD being given as ‘Doctor’ or ‘GP’ rather than registered qualifications (mistake not picked up by ME service).
  • Coroner referring a death back to the GP, but GP not acting on it.
  • ME service advising GP that a death should be referred to the coroner, but this being not done until chased on multiple occasions by the coroner.
  • Providing out of date contact information for relatives which is used by both the ME service and Registrars. This has included on one occasion the name and phone number of the spouse who had died a couple of years earlier.

The problems reported by GPs about the ME service include:

  • Delays (as above), and relatives unable to get through to the ME service.
  • MEs being pedantic about the cause of death insisting on changes that would seem inappropriate.
  • MEs insisting on change in cause of death due to additional information that they have available to them from hospital records. My view is that the legal requirement is for the GP to complete the MCCD with a cause of death to their best belief and knowledge using the information available to them at the time that they complete it.

I am told that Funeral Directors have had many relatives in tears as they have not been able to make any arrangements for the burial or cremation.

The LMC will continue to work closely with the ME service and other stakeholders to try and make the process as smooth as possible, but we must recognise that this is a mandated process with limitation due to the statutory requirements. I plan to develop further guidance based on common scenarios to assist GPs.

The one thing that both Prof Peter Furness (Senior ME) and I completely agree on is that the process is far from ideal, and that one big improvement would be to take GPs out of completing the MCCD, with our only responsibility being to provide basic information to the ME service.

Any comments or concerns, please contact the LMC

Last Updated on 15 January 2025