Establishing a medical examiner system for the NHS

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A new medical examiner system is being rolled-out across England and Wales to provide greater scrutiny of deaths.

Introduction to the medical examiner system

The system will also offer a point of contact for bereaved families to raise concerns about the care provided prior to the death of a loved one. 

Acute trusts in England and local health boards in Wales have been asked to begin setting up medical examiner offices to initially focus on the certification of all deaths that occur in their own organisation. 

The purpose of the medical examiner system is to:

  • provide greater safeguards for the public by ensuring proper scrutiny of all non-coronial deaths 
  • ensure the appropriate direction of deaths to the coroner
  • provide a better service for the bereaved and an opportunity for them to raise any concerns to a doctor not involved in the care of the deceased
  • improve the quality of death certification
  • improve the quality of mortality data.

Medical examiners

Medical examiners are senior medical doctors who are contracted for a number of sessions a week to undertake medical examiner duties, outside of their usual clinical duties. They are trained in the legal and clinical elements of death certification processes.

Medical examiner offices at acute trusts in England

Medical examiner offices at acute trusts will be staffed by a team of medical examiners, supported by medical examiner officers. 

The role of these offices is to examine deaths to:

  • agree the proposed cause of death and the overall accuracy of the medical certificate cause of death
  • discuss the cause of death with the next of kin/informant and establishing if they have any concerns with care that could have impacted/led to death
  • act as a medical advice resource for the local coroner
  • inform the selection of cases for further review under local mortality arrangements and contributing to other clinical governance procedures.

Initially medical examiner offices are being asked to focus on the certification of deaths that occur within the acute trust where they are based. In time, they will be encouraged to work with local NHS partners and other stakeholders to plan how they can increase the service to cover the certification of all deaths within a specified geographical area. This will expand the service to cover deaths in other NHS and independent settings, as well as deaths in the community.

During the non-statutory phase of implementation we, along with the Department of Health and Social Care, will collectively support acute trusts to manage the financial impact of establishing and running local medical examiner offices.

Regional support

Each NHS region will have a regional medical examiner to support the development of medical examiner offices. Regional medical examiners will oversee the provision of services and provide an independent line of advice and accountability for medical examiners at trusts in their region.

The national medical examiner

In March 2019, Dr Alan Fletcher was appointed as National Medical Examiner for England and Wales.

The role of the national medical examiner is to provide professional and strategic leadership to regional and trust-based medical examiners. The role supports better safeguards for the public, patient safety monitoring and improvement, and informs the wider learning from deaths agenda.   

The office of the national medical examiner can be contacted by emailing: nme@nhs.net.

Events and training

The next ‘Implementing the medical examiner system‘ event is being held in London on Thursday 25 April 2019.

This is an information-sharing session aimed at medical directors and those responsible for implementing the medical examiner system in acute trusts, coroners, members of patient groups and faith communities. 

For further information and details of how to register, visit the Royal College of Pathologists website

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