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Death certification laws- 2024 Updates

Starting in September 2024, significant reforms to death certification laws in the UK will enhance the accuracy, quality, and scrutiny of mortality data. These updates aim to streamline the certification process while ensuring that key details about the cause of death are carefully reviewed and documented.


One of the central changes includes the addition of medical examiners who will independently review each Medical Certificate of Cause of Death (MCCD), adding a level of verification to support attending practitioners and improve public health insights. The new MCCD format now has more detailed sections to record the chain of events leading to death and includes specific fields for information on ethnicity, maternal status, and any medical devices or implants.


These updates will impact clinical practice by improving the precision of death reporting, providing crucial data for national and local health analysis, and ensuring a supportive process for families during bereavement. The following outlines the main changes and their implications for healthcare providers in the UK.



Aspect Previous Practice New Practice (from 2024) Impact on Clinical Practice
Mandatory Independent Review Only certain deaths required review by a Medical Examiner or Coroner All deaths in England and Wales must be reviewed by either a Medical Examiner or Coroner Ensures all deaths are independently reviewed, adding scrutiny and accuracy to the process
Attending Practitioner Requirements Practitioner must have seen the patient within 28 days before or after death Practitioner only needs to have attended the patient at any point in their lifetime Easier for practitioners to complete MCCD, removing the need for recent visits
Issuing Medical Certificate of Cause of Death (MCCD) GPs issued MCCDs independently MCCD is sent to Medical Examiner, who reviews the cause and receives patient records Practitioners must work with Medical Examiners and ensure patient records are accessible for review
New MCCD Format Limited lines for cause of death; no fields for ethnicity, pregnancy, or devices Includes additional "line 1d" for cause of death, fields for ethnicity, pregnancy status, and medical devices More detailed recording enhances public health data and aligns with international standards
Medical Examiner Signature Practitioner signs and sends MCCD directly to the registrar Medical Examiner adds their declaration to the MCCD before registrar submission Adds an extra layer of accountability and verification for causes of death
Removal of 28-Day Rule Referral to coroner needed if patient not seen recently by GP Coroner referral no longer needed based on recent visits alone Simplifies MCCD process, reducing unnecessary coroner referrals
Registration Timelines Death registration deadline was 5 days from the date of death 5-day limit now starts when registrar receives MCCD from Medical Examiner Aligns timelines with the review process, potentially allowing more time for accurate certification
Exceptional Circumstances Coroner involvement required if attending practitioner unavailable Medical Examiner may issue MCCD if cause is known and natural; coroner issues form CN1B in these cases Supports timely certification if the attending practitioner is unavailable
Electronic Certification Paper-based death certification Mandatory electronic death certification Streamlines the process, enabling faster data entry and reporting
Cremation Form Changes Cremation Form 4 required in most cases Cremation Form 4 removed; new forms (1, 6, and 10) introduced Simplifies paperwork for cremation, reducing administrative burden on clinicians and families


The 2024 changes to UK death certification laws aim to improve the accuracy, consistency, and transparency of death documentation. These reforms were driven by the need for more reliable mortality data to support public health analysis and policy. By introducing independent reviews from medical examiners, expanding the details recorded on the Medical Certificate of Cause of Death (MCCD), and implementing mandatory electronic certification, the system enhances data quality and provides better oversight.


The addition of ethnicity, maternal status, and medical device information on the MCCD, as well as the removal of the 28-day rule, addresses gaps highlighted in recent years, especially during the COVID-19 pandemic. These updates enable more precise mortality records, support better care for bereaved families, and align the UK’s practices with international standards for greater public health benefits.


Key Impact on GPs in the UK


Aspect Change Impact on GPs
Death Certificate Issuance GPs will no longer issue death certificates independently GPs must now work with Medical Examiners, who verify MCCDs before submission
New Referral Process GPs or duty clinicians must contact relatives to gather information for Medical Examiner referral Adds a new step, requiring GPs to reach out to families, usually within 72 hours
Sharing Information with Medical Examiners GPs must share the MCCD with a Medical Examiner before it’s sent to the Registrar Increases collaboration with Medical Examiners and introduces a step for verification
Wider Pool of Practitioners for MCCDs Removal of the requirement to have seen the deceased within a specific timeframe More practitioners are eligible to complete MCCDs, easing issuance requirements
Potential Increase in Administrative Work GPs may need new processes for referrals and information sharing Likely additional administrative tasks to handle referrals and coordinate with examiners
Possible Delays in Death Registration Medical Examiner involvement may extend certification and registration timelines May result in longer processing times, especially during early stages of implementation
Reduced Need for Coroner Referrals Coroner referrals no longer needed solely based on recent patient contact Streamlines process, reducing unnecessary referrals to the coroner



The 2024 reforms to the UK death certification process, particularly the removal of Cremation Form 4, are expected to impact GP incomes due to the elimination of payments previously associated with the form. 


  1. Removal of Cremation Form 4:

    • Change: Cremation Form 4, which required a doctor’s certification for cremation cases, has been permanently removed for all deaths in England and Wales as of September 9, 2024.
    • Financial Impact: The removal of this form eliminates a long-standing source of additional income for GPs, especially for resident doctors who frequently completed these forms. GPs were typically compensated for each Cremation Form 4 completed, which represented a modest but steady income.


Sharing Patient Records with Medical Examiners:

  • Change: GPs are now required to share relevant parts of the deceased patient’s medical records or a summary with the Medical Examiner.
  • Impact: This requires GPs to prepare and provide patient information in a timely manner, usually within 72 hours of the death, adding an administrative task. However, as most cases do not require a verbal discussion with the Medical Examiner, the administrative burden is partially managed, though still unpaid.

New Obligations without Payment:

  • Change: Under the new system, doctors must declare any hazardous implants directly on the Medical Certificate of Cause of Death (MCCD), replacing what was previously documented on the cremation form.
  • Impact: This additional responsibility is considered a statutory obligation with no associated fee, adding unpaid administrative work for doctors.


Transition to Mandatory Medical Examiner Review:

  • The requirement for all MCCDs to be reviewed by a Medical Examiner for cases not referred to a coroner adds another layer of review without direct compensation for GPs.
  • Impact: This change not only removes payments from cremation form fees but may also increase administrative workload, as GPs must prepare information for Medical Examiners without additional pay.

No Requirement for Verbal Discussion:

  • Change: In most cases, GPs are not required to have a direct conversation with the Medical Examiner, as records or summaries typically suffice.
  • Impact: This limits time spent on discussions and may streamline the referral process, though the GP still needs to compile and provide relevant documentation for review.


Timeframe for Referral:

  • Change: GPs or duty clinicians are expected to send the referral to the Medical Examiner typically within 72 hours of the death occurring.
  • Impact: This new timeframe creates an additional administrative deadline for GPs to meet. While it ensures prompt certification, it may increase pressure on GPs to complete records-sharing quickly, adding to their workload, particularly in busy practices or in cases where record compilation is time-consuming.


Support from Medical Examiners for Complex Cases:

  • Change: Medical Examiners can assist GPs with complex cases, especially where coroner notification is necessary.
  • Impact: Although there’s no financial compensation involved, this support can reduce the administrative and procedural burden for GPs in challenging cases, ensuring that complex certifications are handled more accurately and efficiently.


Nationwide and Permanent Change:

  • This change affects all GPs across England and Wales, marking a shift in an additional income source that many GPs previously had benefited from.

  • Impact: The nationwide reform means all practitioners will experience the same financial adjustments, with no flexibility or alternative income from the removed cremation form fees.


References


1. https://www.parkmedical.org.uk/2024/10/02/sept-2024-new-medical-examiner-changes-for-death-certificates/
2. https://www.gov.uk/government/publications/changes-to-the-death-certification-process
3. https://www.kctrust.co.uk/blog/revolutionising-death-certificates
4. https://portcullis-surgery.co.uk/changes-to-the-death-certification-and-registration-process-effective-from-september-2024/
5. https://www.nafd.org.uk/2024/09/09/death-certification-reforms-in-england-and-wales-go-live-just-after-midnight/
6. https://www.gov.uk/government/publications/changes-to-the-death-certification-process/an-overview-of-the-death-certification-reforms
7. https://www.england.nhs.uk/long-read/national-medical-examiners-guidance-for-england-and-wales/
8. https://www.reddit.com/r/doctorsUK/comments/1fnlzwd/cremation_form_and_fee_removed_for_doctors/
9. https://www.gov.scot/publications/funeral-expense-assistance-scotland-amendment-regulations-2024-business-regulatory-impact-assessment/
10. https://www.gov.uk/government/collections/cremation-forms-and-guidance
11. https://www.gov.uk/government/publications/medical-practitioners-guidance-on-completing-cremation-forms