What happens when someone dies?

When a person dies, one of the first steps for their representative or relative is to obtain a death certificate.

Depending on the cause of death, there will either be an investigation by a coroner, or medical certification by a medical practitioner.

This is usually either the GP, or the Hospital Doctor, or Hospice Doctor, who had been taking care of the patient in their last days of life.

All deaths in England and Wales, without exception, now require an independent review (by either a Coroner or Medical Examiner). This change was introduced in 2024, after a new law.

Medical examiners are senior NHS doctors, from either a hospital or general practitioner setting, who, after completing specialist training, work part time in this role.

Their job is to give an independent view on causes of death and the care provided (except for deaths which have to be investigated by a coroner). 

Medical Examiners review the patient care records as well as the cause of death proposed by the attending practitioner (GP, Hospital Doctor, etc), who had knowledge of, or involvement in, the care of the deceased.

Your conversation with the Medical Examiner

As a relative or representative of someone who has died you will be asked if you would like to have a conversation with the Medical Examiner, or their officer, about anything that may be worrying you about how the person who died was cared for.

The purpose of this discussion is to increase understanding and peace of mind for families.

The Medical Examiner or Medical Examiner officer will explain what is written on the Medical Certificate of Cause of Death and why.

You may simply want to better understand why the person died, including by having medical terminology explained, or you may want to raise something about the care which did not feel right or ideal.

This is your opportunity to ask questions and raise concerns.

Medical Examiners and Medical Examiner Officers will discuss your feedback, questions and concerns.

If they consider any issues with care need further investigation, they will refer these to someone who can do this work.

As well as answering your questions, talking to a Medical Examiner helps the NHS provide better care for other patients and carers in future; for example, by identifying ways in which patient and family care could be improved.

Increased timescales for registering a death

It may take longer for deaths to be certified and registered due to the additional step involving the Medical Examiner.

Notification of deceased’s representative

The deceased’s representative will not be able to register the death until the Medical Examiner has sent the MCCD to the Registrar (in some cases this may take longer than 5 days).

Changes to death certificates

New death certificates, introduced as a result of the changes introduced in 2024, include some different information, such as the new categories of informant (deceased’s partner or representative).

Greater efficiency in coroner cases

Over time, the involvement of medical examiners should streamline cases requiring coroner intervention.

For further information:

https://www.gov.uk/government/publications/changes-to-the-death-certification-process/an-overview-of-the-death-certification-reforms#updated-guidance

https://www.england.nhs.uk/patient-safety/patient-safety-insight/national-medical-examiner-system

https://www.rcpath.org/profession/medical-examiners/the-role-of-medical-examiners-and-medical-examiner-officers.html

For Derbyshire County deaths:

https://www.derbyshire.gov.uk/community/births-deaths-marriages-and-civil-partnerships/deaths/registering-a-death.aspx

For Derby City deaths:

https://www.derby.gov.uk/community-and-living/deaths-funerals-cremations/deaths

The Medical Examiner Service has been introduced in England and Wales to increase understanding and peace of mind for families, as well as to improve learning and patient safety by providing a review of care.

Following the death of your relative/friend, the doctor who is completing the Medical Certificate of Cause of Death will discuss this with the Medical Examiner.

The Medical Examiner is an independent senior doctor who will review the relevant medical records to establish the cause of death and ensure that care was provided appropriately. They will direct the doctor to refer to the Coroner if further investigations are required.

Once the paperwork has been completed, you will receive a call from the Medical Examiner’s Office to explain the details on the certificate.  During this call, you will be given the chance to discuss any concerns about the cause of death, or about the care the person received before their death.  The Medical Examiner’s Officers can explain any medical language unfamiliar to you if this is needed. They will inform you that the relevant paperwork will be at the register office and following this call, you will be able to make an appointment to register the death formally.

If there are any concerns that need to be escalated following this discussion, this can be done by the Medical Examiner’s Officer, or they will provide you with the relevant contact details.