Sudden Death Policy - Across Hampshire & IOW Only
Under the system operating until 1st April 2019, the coroner’s office has been notified of unexpected deaths which occur in the community via a police form (Form G28).
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 ie 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 Central, Southampton and New Forest, the Coroner’s office has been sending a form through to the GP surgery asking if a GP can issue a death certificate or not. In North East Hampshire this contact is made by telephone.
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 are 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.
The recent change to the sudden death policy in this area simply means that the coroner’s office will not be automatically informed when a death occurs in the community and it is of seemingly natural causes. The notification that the patient has died will now be made to the GP surgery via the ambulance service via an email summary of the encounter with the ambulance service.
The only change is that the GP will find out about the death from the ambulance service rather than the coroner’s service.
If the GP feels happy to issue an MCCD, and has seen the patient in the past 14 days – then do so
If you are happy to issue an MCCD but you have NOT seen the patient within the last 14 days – refer to the Coroner for advice explaining you would be happy and what you suggest but you need their authorisation
If the GP feels unable to determine a cause of death to write on the MCCD - refer to the Coroner for advice - the Coroner may request from another doctor involved in their care eg hospital doctor or may request a post mortem
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 eg 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 have 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 have 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.