EOL, Death and Cremation Certification
Update Verification of death, Medical Certification of Cause of Death (MCCD) and Cremation form 4 from 25th March 2022
The Coronavirus Act 2020, which introduced easements to death certification processes and cremation forms, expires at midnight on 24 March 2022. Some changes have been retained on a permanent basis through other measures, and other processes revert to previous practice. Below is a reminder of existing processes and an update of the changes to come into effect. Reviewing of these processes has made it clear that there are historic practices that GPs may have followed which are time consuming and may be unnecessary.
Verification of death (identifying a person has died) Verification tends to be performed by registered health care professionals informed by their code of conduct (commonly District Nurses, Paramedics or GPs) GP’s are not obliged to attend a scene a death has occurred. For expected deaths from apparently natural causes anyone may verify death (which would include funeral directors or family members) GPs may choose to assist families to do this remotely or in person.
Medical Certification of Cause of Death (MCCD)
- • Making permanent the attended period before death to 28 days (it was 14 days prior to the pandemic)
- • Revert back to ‘Certifying Medical Practitioner will need to have been in attendance during the deceased last illness’ ( temporarily any Medical Practitioner under Coronavirus Act 2020)
- • Continuation of electronic transfer of MCCD
What conditions enable a MCCD to be issued without coroners’ permission? A medical practitioner with GMC registration who has attended the deceased for their last illness and can state the cause of death to the best of their knowledge if either of the below conditions are met
- Attended (in person or via video link but not telephone/audio) the deceased during their final illness up to 28 days before death OR
- Viewed the body in person after death, and can state the cause of death to the best of their knowledge and belief.
Please remember to submit the above information to your local Medical Examiner prior to issuing the MCCD in those practices that are enrolled into a ME process.
What if above conditions cannot be met? A MCCD can still be completed by the medical practitioner if they can state the cause of death to the best of their knowledge and belief, but this will require coroner notification at registration, or preferably by the medical practitioner beforehand to avoid distress to the bereaved. The coroner may then complete Form 100A and send this to the registrar to allow registration. If no medical practitioner can state the cause of death to the best of their knowledge and belief, the coroner will have to be notified. It would then be for the coroner to determine the cause of death.
The coroner must be notified for any death that is unexpected, unnatural, violent or of an unknown cause. An unexpected death is one that is: not anticipated or related to a known illness that has been previously identified or unnatural or unexplained.
Registration of MCCD
- Electronic transfer is preferred - the MCCD is scanned or photographed and sent from a secure email account to registrars as an attachment.
- Where electronic transfer is not possible, a paper MCCD can still be issued to a qualified informant for them to deliver to the registrar. It must not be given to the family
- Next of kin/informant will need to register the death in person.
The legal requirement remains that a death must be registered within 5 days, unless there has been Coroner involvement.
It would be helpful if surgeries could forward contact details for the deceased’s family when emailing the MCCD to the Register Office, so the family can be contacted asap to make an appointment for the registration.
Cremation forms revised guidance for medical practitioners
- Making permanent the attended period before death to 28 days (it was 14 days prior to the pandemic)
- Electronic PDF Form 4 available, if submitted by nhs email of GP completing the form this acts as electronic signature
- Crem Form 5/ part 2 by second Doctor not to be re-introduced
Form 4 (Cremation Medical Certificate) replacing Form B This is the form GPs will be familiar with, the questions have not changed. The requirements for a medical practitioner to complete cremation form 4 are the same as for the MCCD
- Attended the deceased (including visual/video consultation) within 28 days before death OR
- Viewed the body in person after death
Cremation Form 4 is now an interactive PDF document and can be completed and saved before sending, or paper copies can be scanned/photographed and submitted electronically. An added electronic signature is not required if the form is sent from the secure (nhs.net) email account of the person completing the form.
Why does the above guidance (not new) suggest I do not have to see a body after death to complete a Crematorium Form 4?
It is our understanding that there is no legal requirement to view the body after death to complete a Form 4 so for Qu 8 "Please state the date and time that you saw the body of the deceased and the examination that you made..." the Doctor can opt not to examine and answer ‘N/A’. This process is helped if you enter the name of the professional who verified the death in Qu 9. However, it is ultimately for the crematorium referee (who is an appointed Doctor) to decide whether they accept this. We are aware this might be different to historic practice but in fact is not a change in the law or legislation. We are planning to work with Crematorium medical referees as clearly not having to see a body after death could save hours of GPs time.
Form5 (confirmatory Medical Certificate) part 2 (second Doctor component) It is the government’s intention that it will not be re-introduced
Sources : Coronavirus Act expiry – Death certification and registration easements from 25th March 2022 The Cremation(England and Wales) (Amendment) Regulations 2022 GP mythbuster 13 :Verification and certification of death : CQC The National medical examiner system NHS England