Certification - Deaths
The law requires a doctor to notify the cause of death of any patient whom he or she has attended during that patient’s last illness to the Registrar of Births and Deaths. The doctor is required to notify the cause of death as a certificate, on a form prescribed, stating to the best of his or her knowledge and belief, the cause of death.
It should be noted that the strict interpretation of the law is that the doctor shall notify the cause of death, not the fact. Thus, a doctor does not certify that death has occurred, only what in his or her opinion was the cause, assuming that death has taken place. Arising out of this interpretation there is no obligation on the doctor even to see, let alone examine the body before issuing the certificate. The Broderick report recommended that a doctor should be required to inspect the body of a deceased person before issuing the certificate but this recommendation has never been implemented. Thus, there is no requirement in English law for a general practitioner or any other registered medical practitioner to see or examine the body of a person who is said to be dead.
General practitioners as a body would not, and as individuals should not, seek to use this quirk of English law to avoid attending upon an apparently deceased patient for whom the GP is responsible.
However, the fact that there is no legal obligation upon a GP to attend the deceased should be remembered and, if necessary, quoted when organisations such as the emergency services ask general practitioners, either in or out of hours, to attend a the deceased as a matter of urgency. If a patient is declared to be dead by a relative, a member of staff in a nursing home, ambulance personnel or the police, GPs would be acting correctly by prioritising the needs of their living patients.
On a parallel basis, case law exists to confirm that a NHS general practitioner does not have a contractual obligation to attend upon the body of a patient declared to be dead. Once again the fact that a contractual obligation does not exist should never be used by GPs to avoid the ethical and moral responsibility to make the experience of bereavement as gentle and easy as possible for relatives and friends.
Medical Certificate of Cause of Death
You can download Guidance for doctors completing Medical Certificates of Cause of Death in England and Wales from here which includes guidance on using the term "old age" as a cause of death. Reforms to the Death Certification process are being considered and you might also like to download the Guidance on proposed death certification reforms which contains some useful FAQs.
Completing Form 5's (Part 2's)
Just a reminder on who can complete cremation Form 5’s (formerly Form C or Part 2). Regulation 9 of the Cremation Regulations states that in order to be eligible to complete cremation Form 5, you must be a “registered medical practitioner of not less than five years' standing.” The Department for Constitutional Affairs takes the view that this requires a continuous period of registration at the relevant time. As far as limited registration is concerned, periods of temporary or provisional registration would not seem to disqualify a registered doctor from completing a confirmatory certificate, but it will be a matter for the medical referee to decide whether an inadequate length of full registration may be a factor to be taken into account in any particular case.
The medical practitioner who completes the confirmatory medical certificate should not be a relative of the deceased, or a partner of the doctor who has given the cremation certificate in Form 4.
Locums and former partners are permitted to complete cremation Form 5, however, we would advise these doctors not to complete cremation Form 5 for practices where they regularly or have recently worked. Here you can access a Guidance for Medical Practitioners completing cremation 4 and 5 .
GMC Numbers and Death Certificates
On signing the death certificate, the patient's next of kin takes the certificate to the Registrar. With the new GMC License to Practice some registrars have been asking for a list of doctors who are licensed.
It would therefore be helpful (although not obligatory) for GPs to sign the certificates and put their GMC number or some other clear identifier so that the Registrar can go on line and identify the doctor and check their license.
Coroners Reports & Contact Details for Wessex Coroners
We advise that providing basic medical information for a Coroner's Report is your duty, however, a more detailed report may be asked for. There is nothing n the Coroners Act that clearly stipulates a fee for reports where payment is not being offered. The BMA advises doctors to complete the report otherwise they may face being summonsed.
Working within an established legal framework it is the principal statutory duty of Coroners to investigate deaths which are reported to them and which appear to be due to violence, or are unnatural, or are sudden and of unknown cause, or which occur in legal custody. They are entitled to request medical information that is relevant and necessary to their enquiries.
The GMC sets out clearly in Good Medical Practice that 'You must assist the coroner or procurator fiscal in an inquest or inquiry into a patient's death by responding to their enquiries and by offering all relevant information. You are entitled to remain silent only when your evidence may lead to criminal proceedings being taken against you.'
Viewing the Body
The have been instances of undertakers taking deceased patients into GP car parks to avoid inconveniencing the GP providing cremation certification. We would strongly advise against this on the grounds of the distress it would cause to the family and your other patients if they discover this practice happening.
We realise this may be a particular difficulty in some more rural areas but believe that the Undertakers could arrange to move the body to a more local undertaker to care for the body whilst waiting to be viewed.
You may also want to take a look at Deaths in Nursing or Residential Homes on this site.
Free from Infection Certificate / Information
If a patient passes away and the family would like repatriate them to their country of birth, a ‘Free from Infection Certificate’ will be required from the Undertakers. The following provides information on what is required by the GPs in this instance:
- If the patient has had a post mortem the information needs to be provided by a Pathologist from the hospital where this took place
- If the GP has issued the death certificate this will then need to be provided by the GP
- There is, as such no formal certificate, however a letter will need to be provided
- This will need to include information regarding the infection status of the following:
- Hep B
- Hep C
- This is not core GMS work therefore you are able to charge for this
The Role of the GP when a Patient Dies in a Residential or Nursing Home
The attached letter provides guidance regarding the procedures relating to the death of a patient under a homes care.
With thanks to Bedfordshire & Hertfordshire LMC for providing this letter
The Respective Roles of Coroners and Doctors in Certification of Death
The Coroner’s office is tasked with establishing who has died, and how, when, and where they died. However, they are not medical, so they need specialist medical input to advise them what the cause of death is. If it is not clear or unnatural then the Coroner will seek further specialist medical input i.e. post mortem or other expert opinion to advise them in making the decision.
The medical specialist who is most often in the position to be able to advise on the cause of death is the patient’s GP who manages the vast majority of a patient’s care. The statutory duty to fill out the death certificate rests with the doctor who has cared for the patient. Therefore, the Coroner will contact the patient’s GP.
In many cases a GP has sufficient knowledge of the patient’s disease or recent health and therefore can offer a cause of death. This applies even if the GP has not seen the patient within the last 14 days. For example, a patient may be known to in a terminal phase of cancer and being cared for at home. In this case, after referral to the Coroner, if the Coroner accepts the cause of death, the coroner’s office will issue paperwork to the Registrar to prove the cause of death has been authorised and the GP circles numbers 3 and 4 on the back of the MCCD.
The death certificate can only be issued by a doctor. The Coroner is not a medical professional and cannot issue death certificates.
The Coroner needs the input of the relevant doctor – either GP or hospital – as to whether they are able to determine a cause of death to put on the MCCD. Until a GP (or hospital doctor) has made this decision, the Coroner’s office is unable to progress with any investigations that might be needed if they cannot issue.
Conversations can be held between Coroner’s Officers (or even the Coroner directly, in North East Hampshire) and GPs in relation to the cause of death and whether they can issue a certificate, however this is only advice and neither Officers nor the Coroner can tell a GP or Doctor what to write. The GP will use their knowledge and that contained within the patient record to decide whether they can determine a cause of death.
If the GP feels happy to issue an MCCD – then do so
If the GP feels unable to determine a cause of death to write on the MCCD and/ or has not seen the patient within the last 14 days – refer to the Coroner for advice
If the GP suspects the death is unnatural then refer to the Coroner
Common scenarios that cause confusion:
- My patient has been managed by the community team e.g. specialist heart failure nurses I have spoken to the patient on the phone, but a home visit or surgery appointment has not been needed by me in the past 14 days as the appropriate care is being provided by other specialists. The patient has now died. The ambulance service has now contacted us to say the patient has died. What should I do?
You can determine a cause of death to write on the MCCD. You are therefore in a position to issue an MCCD if the coroner is happy. Refer to the coroner asking for authorisation
- My colleague has been caring for a patient with terminal cancer. The patient has now died. The doctor is in Outer Mongolia for the next month. The ambulance service has just contacted us to let us know the patient has died. What should I do?
You can determine a cause of death to write on the MCCD. You are therefore in a position to issue an MCCD if the coroner is happy. Refer to the coroner asking for authorisation.
- My patient has just been discharged from the hospital after a lengthy stay. They have been seen by our community nursing team and we had a planned visit next week. However, the ambulance service have just informed us that the patient has died. I have not seen the patient since discharge.
- The discharge paperwork is clear that patient is expected to die soon from a known cause
- You would refer to the coroner as this is more likely to be appropriately completed by the hospital doctor.
- The discharge paperwork contains a number of diagnoses, but I am not able to say what they have died from based on this information only
You would refer to the coroner as this is more likely to be appropriately completed by the hospital doctor or the coroner may need to instigate further investigations.
- The cause of death is not clear. The Coroner asks for a post mortem. Does the Coroner issue the MCCD in this case?
No, in this case the pathologist who carried out the post mortem will provide the Coroner with a cause of death and the Coroner will then send a ‘Form B’ to the Registrar to enable the death to be registered.
Sudden death policy - Across Hampshire and Isle of Wight Police area
Please refer to our webpage - https://www.wessexlmcs.com/suddendeathpolicyacrosshampshireiowonly