MCCD and Cremation form 4

The COVID-19 Act sets out emergency provisions for the Medical Practitioner undertaking the certification of death and completion of the cremation forms.

MCCD

The Births and Deaths Registration act 1953 states that the doctor who attended the deceased during their last illness has a legal duty to complete a MCCD and arrange for delivery of it to the relevant registrar as soon as possible to enable the registration to take place. The attendance should be within 14 days of the death, or they must have viewed the body after death.

The current emergency legislation bought in to help manage with COVID-19 pandemic includes amendments to allow the attending doctor to issue a MCCD if:

• The attendance was during the previous 28 days, and that ‘attendance’ can be in person or by video link but cannot be audio (i.e. telephone) only  or
• He or she has viewed the body after death.

The emergency legislation also  allows for a registered medical practitioner who is not the practitioner who attended the deceased during their last illness may sign a MCCD if:

• The practitioner who attended is unable to sign the MCCD or it is impractical for them to do so and
• The medical practitioner who proposes to sign the MCCD is able to state to the best of their knowledge and belief the cause of death, providing that the deceased had been attended to by a medical practitioner within the 28 days before death.

A registered medical practitioner may sign a MCCD even in the case of a person who has not been attended during their last illness by a medical practitioner if:

• The registered medical practitioner is able to state to the best of their knowledge and belief the cause of death and
• If the medical practitioner has obtained agreement from the coroner they can complete the MCCD.

Where you are not the attending practitioner the declaration on the MCCD should be amended to record whether there has been a medical practitioner in attendance or not, and if not, whether another doctor has seen the deceased within 28 days or after death. The after death requirement should utilise the existing ringed boxes. MCCD’s must be wet signed but may be scanned and transmitted to the registrar electronically via secure and personal work email address.

Guidance from the ONS should still be adhered to when formulating a cause of death for the MCCD  and acceptable wording for Registration purposes should be considered. The standard ‘how to’ guidance for completing the MCCD from the GRO can be found here: https://www.gov.uk/government/publications/guidance-notes-for-completing-a-medical-certificate-of-cause-of-death.

Advice on formulating a cause of death and acceptable wording and phrases for registration purposes can be found here: Death Certification Central Hub Advice MCCD – Formulating a cause of death and acceptable wording and phrases

Cremation form 4

The requirement to complete the confirmatory medical certificate (form Cremation 5) has been suspended and cremations will be authorised on Cremation from 4 and Cremation form 10.

The requirement for form Cremation 4 to be completed by the attending medical practitioner is suspended. Any medical practitioner can now complete form Cremation 4, even if they did not attend the deceased during their last illness or after death, if the following conditions are fulfilled:

• The medical practitioner who did attend the deceased is unable to sign the form Cremation 4 or it is impractical for them to do so and,
• A medical practitioner has seen the deceased (including audio-visual / video consultation) within 28 days before death, or has viewed the body in person after death (including verification).

Full guidance on this can be found here: https://www.gov.uk/government/publications/medical-practitioners-guidance-on-completing-cremation-forms

The Cremation from 4 remains unchanged and a PDF version and can be found here: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832911/cremation-form-4-medical-certificate.pdf

It can be completed, signed and submitted electronically directly to the crematoria. An electronic signature includes the document being sent from the secure email account of the person completing the Cremation form 4.

Under the new legislation, an examination of the body is not required for completion of form Cremation 4 if the deceased was seen either: 

• after death by a medical practitioner (including verification), or 
• by a medical practitioner in the 28 days before death (including visual/video consultation). 

A Medical Practitioner undertaking the role of a Qualified Death Certifier should document all discussions, reviews and conclusions in the event that they are later asked to justify or explain their decisions or rationale. An exemplar case record form can be found here: QDC case record pro-forma

Advice on how to complete a MCCD and Cremation form 4 when you are not the attending doctor can be found here:

• Death Certification Central Hub Advice Completion of the Cremation form 4 by a Medical Practitioner who has not been in attendance in the Deceased’s last illness.
• Death Certification Central Hub Advice Completion of the MCCD by a Medical Practitioner who has not been in attendance in the Deceased’s last illness.

The Royal College of Pathologists have produced a flow chart to assist in determining if another qualified medical practitioner can undertake the completion of the MCCD and cremation form 4 when the clinical team is unable to do so www.rcpath.org/uploads/assets/742a20f2-f0d3-4e46-8a76843c32882cbf/G213-MCCD-completionduring-COVID-19-outbreak-flowchart.pdf

It is important to remember though, that the clinical team may still wish to have some input into formulating the cause of death, or may be aware of further information that may alter the outcome. We strongly advise that the clinical team either document in the medical records their thoughts on the cause of death, or a brief discussion is held if there is any uncertainty regarding the circumstances, or if the qualified death certifier feels that cause maybe unknown.

This will prevent unnecessary cases being referred to the coroner for further investigation, and will allow the clinical team responsible for the patient an opportunity to contribute to the formulation of the cause of death. An example proforma for completion by the clinical team can be found here.