About Medical Examiner Service

What is the Medical Examiner Service?

The All Wales Medical Examiner Service provides independent scrutiny of all deaths that occur in Wales that are not referred directly for investigation to His Majesty’s Coroner.

Medical examiners are senior medical doctors who are contracted to provide independent scrutiny of the causes of deaths not investigated by coroners, outside their usual clinical duties. They are trained in the legal and clinical elements of death certification processes. They have statutory responsibilities which are set out in regulations. Medical examiners:

provide greater safeguards for the public by ensuring independent scrutiny of all non-coronial deaths
ensure the appropriate direction of deaths to the coroner
provide bereaved people with an opportunity to ask questions and raise any concerns to someone not involved in the care of the deceased
improve the quality of death certification
improve the quality of mortality data

Standards guidance for England and Wales

Standards for medical examiners are set by the National Medical Examiner for England and Wales, who is appointed by the Secretary of State for Health and Social Care.

The National Medical Examiner’s guidance for England and Wales sets out these standards, and provides guidance for implementing them.

What medical examiners do

Medical examiners seek to answer 3 questions:

What caused the death of the deceased?
Does the coroner need to be notified of the death?
Was the care before death appropriate?

Medical examiners answer these by providing independent scrutiny, with 3 elements:

a proportionate review of relevant medical records
interaction with the doctor completing the Medical Certificate of Cause of Death (MCCD)
interaction with a bereaved person, providing an opportunity to ask questions and to raise concerns

Medical examiners’ conclusions can inform learning to improve care for future patients, and in a minority of cases are referred to established clinical governance processes for further review.

FAQs

How long does the process take?

Based on the scrutiny process the Medical Examiner will agree a cause of death with the doctor who has been involved in the care of the person who has died (the Qualified Attending Practitioner) to allow the death to be registered with the Registry Office.

The Medical Examiner’s scrutiny process commences when we receive the medical records, a proposed cause of death from the clinical team, and the contact details for the family. The scrutiny process will take between 24 and 72 hours and the next of kin will be contacted during this time.

Once the completed MCCD has been received from the attending practitioner, the ME will check it has been completed in line with the current regulations and countersign the MCCD, we will then send this to the register office - the register office will then contact the family to arrange an appointment to register the death over the following 5 days

In a small minority of cases it may not be possible to meet this timeframe (if it has been identified that further investigation by the coroner is required and that this will require access to the body for example), but every effort will be made to ensure that any delay is kept as short as possible and that the requirements of the faith and the bereaved are met.

How is the Service accessed?

In general terms there is no need to contact the Medical Examiner Service directly as a Medical Examiner Officer will contact the relevant individuals, such as the Qualified Attending Practitioner and the Next of Kin recorded in the records of the person who has died. However if you would like to speak to the team please contact them using the details at the end of the page.

Any concerns raised by the bereaved will be considered by the Medical Examiner undertaking the review and any findings or outcomes will be discussed with the bereaved by the Medical Examiner or Medical Examiner Officer when the scrutiny is complete. If the Medical Examiner feels that there were issues with care or events revealed through scrutiny of the clinical notes or from discussion with the Qualified Attending Practitioner (a doctor, on behalf of the clinical team that treated the patient before they died) this will be fed back to the Next of Kin and the relevant care organisation for further action.

The Medical Examiner Service does not undertake further investigation of cases where concerns have been identified, this is the responsibility of the care organisation concerned.

Roles within the Medical Examiner Service

The Medical Examiner Service for Wales reviews clinical records and interacts with qualified attending practitioners and the bereaved to address three key questions:

What did the person die from? (Ensuring accuracy of the medical certificate of cause of death)
Does the death need to be reported to a coroner? (Ensuring timely and accurate referral – there are national requirements)
Are there any clinical governance concerns? (Ensuring the relevant notification is made where appropriate)

In undertaking this function, the Service employs two main roles:

Medical Examiners

Medical Examiners undertake the three stage scrutiny process on all deaths not reported directly to a Coroner.

Through a proportionate scrutiny of the clinical notes, discussions with the Qualified Attending Practitioner, on behalf of the clinical team that treated the patent before death, and discussions with the bereaved, they verify clinical information on Medical Certificates of Cause of Death and ensure that referrals are made to the Coroner or to the appropriate care organisation for further investigation where appropriate.

The Medical Examiner may delegate authority to Medical Examiner Officers to liaise with clinical teams and the bereaved as part of the scrutiny process, but they remain accountable for completion of the necessary steps required for compliance with all legislation related to death certification and allied processes.

Who can be a Medical Examiner?

Any practising, or recently retired, medical practitioner who has been fully registered for at least five years and has a licence to practise with the General Medical Council (GMC) can apply to be a Medical Examiner. The National Medical Examiner recommends that Medical Examiners should be consultant grade doctors or GPs with an equivalent level of experience who have completed the Royal College of Pathology Medical Examiner Training Modules. Non-medics cannot perform the role of the Medical Examiner.

The Medical Examiner Service for Wales also evaluates on going practice via a specifically developed Medical Examiner Competence Framework.

It is typical for Medical Examiners to work a fixed number of sessions per week and although the number of sessions contracted is flexible most Medical Examiners tend to undertake between 1 and 3 sessions per week.

Get in Touch

If you have a query for our Medical Examiner Service. Please contact us below.

Please do not use this mailbox if you are sending or requesting information relating to the scrutiny of the deceased, please contact your local hub.