Frequently asked questions
Running a medical examiner system
Who can become a Medical Examiner (ME)?
Medical examiners are senior doctors (at least 5 years post-registration). The majority are consultants or experienced GPs and will be practising in England, Wales, Northern Ireland or Gibraltar.
Are medical examiners all pathologists?
Absolutely not. MEs from England, Wales, Northern Ireland and Gibraltar come from all medical and surgical specialties and general practice. An ME service benefits from having MEs from a range of clinical backgrounds.A template job description for Medical Examiners is available.
Do you have to be a doctor to work as a medical examiner?
Yes, only doctors can work as MEs. If your background is as a nurse, healthcare scientist, paramedic, coroner’s officer, bereavement officer or similar, you may be interested in the role of Medical Examiner Officer (MEO).
I’m an international medical graduate – can I apply to be a medical examiner?
Yes, as long as you meet the requirements and are currently registered with the GMC with a licence to practise. To work as a medical examiner, you need to be practising in England, Wales, Northern Ireland or Gibraltar, you must be on the GMC Register and have at least five years’ post-qualification experience.
Who employs medical examiners?
MEs are currently employed by acute trusts in England, and NWSSP in Wales.
Is being a medical examiner a full-time job?
Most MEs work part-time in the role, with the majority of their time being spent in their clinical role. Some MEs work 1 programmed activity (PA) per week, others work 2 PAs on alternate weeks, for example. The exact amount of time spent on ME duties is decided locally, but it is advised that MEs undertake an average of at least 1 PA per week to maintain their expertise.
What do medical examiners do?
MEs seek to answer 3 questions about every death:
- What did the person die from?
- Does this need to be reported to the Coroner?
- Are there any clinical governance issues?
They do this via 3 steps:
- Proportionate review of the patient’s medical record
- Discussion with the attending doctor
- A conversation with the bereaved family.
How do I get a job as a medical examiner?
MEs are appointed locally in England. Trusts are encouraged to advertise posts via NHS Jobs. If you work in a trust and are interested in working as an ME, you should contact your local ME office to ask about any vacancies that might be coming up. Find out more information about roles in Wales.
If medical examiners are employed in their own hospital, how can they be independent?
MEs never review cases where they were involved in the patient’s care, so are always independent of the team who cared for the deceased. Those who work in medical roles within the NHS are accustomed to having different roles and different lines of accountability and to making this work, and it is expected that NHS acute providers respect this distinction. Appraisal and revalidation processes will support independence. Engagement with senior coroners is encouraged at the outset and specifically to support appointment committees. In Wales, medical examiners are employed by the NHS Wales Shared Services Partnership, supporting their independence.
Am I indemnified for my work as an ME?
As MEs are employed by acute trusts or NWSSP, you have the same indemnity that you would have for your clinical work for the organisation. You may wish to have additional cover with a medical defence organisation, as you do for your clinical work. Although ME work is generally regarded as being low risk, you should inform your MDO that you are undertaking this work.
Do I have to discuss my ME work at my annual appraisal?
Yes, review of your ME work should form part of your whole practice appraisal. You should include information about your ME work, related CPD, any complaints or reflective learning, and feedback from colleagues and bereaved relatives where possible. Advice about supporting information for appraisal and revalidation is available here.
What training do I need to do to be a medical examiner?
For MEs practising in England, Wales, Northern Ireland or Gibraltar training consists of completion of 26 e-learning modules, which take 8-10 hours in total. This is followed by a face-to-face training day, which is currently delivered via Zoom. Once you’ve completed all the training, you will be invited to join the RCPath as an ME member, which entitles you to use the post nominals RCPathME while you remain a member.
Does completing the training entitle me to a job as a medical examiner?
No, completing ME training only demonstrates that you have the knowledge and skills to work as an ME, it does not give any entitlement to employment. You must apply for a job in an acute trust or NWSSP.
What are the benefits of joining RCPath as an ME member?
RCPath members receive regular e-newsletters with information about progress with ME implementation and recent publications. They also have access to priority booking and reduced registration fees for events such as training days and the Medical Examiner Annual Conference. The benefits also include access to member publications, such as the Bulletin. Find out more about the benefits of membership.
Do I have to join RCPath to work as a medical examiner?
No, College membership is completely voluntary and you can work as an ME without being a member. You can only use the post nominals RCPathME while you are a member of the College.
Is there an annual charge for becoming and remaining an ME or MEO member of the College?
There is an annual charge when applying, which covers your membership and access to a range of benefits, including the use of RCPathME/MEO post-nominals.
I am already a Fellow of the College. Can I use the post nominals RCPathME as well as FRCPath?
Yes, as long as you complete the application form to become a medical examiner member after completing your training. There is no additional charge to become an ME member if you are already a Fellow of the College and if you are practising in England, Wales, Northern Ireland or Gibraltar.
Medical examiner officers
What do medical examiner officers do?
MEOs work closely with MEs to deliver the service. They may undertake some of the tasks above, under delegated authority of the ME. Where the MEO completes the delegated task, they must clearly record their actions. The ME must review the patient record themselves. MEOs typically spend more of the working week in the ME office, and therefore provide continuity and oversight of the service that MEs, who are usually part-time, cannot.
A job description for MEOs is available here.
Is there any training for medical examiner officers?
Yes, MEOs practising in England or Wales can complete the same 26 core e-learning modules as MEs, and attend a face-to-face training day, specifically developed for MEOs. Further useful information, including a training record for MEOs, is available here.
Can a Medical Examiner service be run without medical examiner officers?
It is possible, but not advisable. The funding for ME service assumes that there are more MEOs than MEs in a service. Staffing a service with MEs only is likely to cost more than the funding available will allow.
Running a medical examiner system
How is the Medical Examiner service funded?
Before the pandemic, the ME service was largely funded by income from completion of Cremation form 5 by MEs. Since the Coronavirus Act 2020 was enacted, the requirement for cremation form 5 has been suspended, and income is topped up by the Department of Health and Social Care (DHSC). There has always been top-up funding for cases where no form 5 funding was available, such as burials, under 18s and cases investigated by the Coroner.
How many MEs and MEOs do I need?
The DHSC funding model for ME services is based on 1 WTE ME and 3 WTE MEOs for every 3000 deaths. If your service deals with 2000 deaths, for example, the funding will support 2/3 WTE ME and 2 WTE MEOs. NHS England and NHS Improvement agree a funding envelope based on staffing costs required for the expected number of deaths.More information about setting up an ME service is available in the National Medical Examiner’s Good Practice Guidelines.
How does funding for the ME service reach the employing organisation?
In England, ME services submit quarterly reports to NHSE, detailing the number of deaths dealt with. In Wales this is done through the Welsh Government. More information about reimbursement is available here
Working on cases
I have completed my training but am still not sure whether a case should be referred to the Coroner
Guidance on when to notify the Coroner of a death is available here. If in doubt, you should discuss the case with your local Lead ME, or other ME colleague, or contact the Coroner directly to discuss the case. As you and the Coroner become more familiar with the way the local ME service functions, you are likely to develop an understanding about which cases do, and don’t, need to be referred. It is very helpful to develop a close working relationship with your Coroner so that you can discuss cases quickly and easily.
What is the Cause of Death List?
The Cause of Death (COD) List is a document published by the RCPath, in close collaboration with the GRO. It lists some of the causes of death that have caused concerns in the past when written on the Medical Certificate of Cause of Death (MCCD). Registrars are not medically qualified and have to determine whether a cause of death requires referral to the Coroner. The COD List clarifies some causes of death that are acceptable or unacceptable. It is not an exhaustive list of every possible cause of death. The COD List is updated regularly. If you have a query or suggestion, please email [email protected].
If a death has been reviewed by a medical examiner, why would the registrar reject it?
Registrars are required by law to refer certain deaths to the Coroner, irrespective of whether a medical examiner has already reviewed the case. Even if an ME has approved a cause of death, if it mentions a fall, fracture or surgical procedure, for example, the registrar will refer it to the Coroner. MEs should be aware of the conditions that require Coroner notification and ensure that they are referred before the MCCD is issued. It is also helpful for MEs to get to know their local registrars and encourage the registrar to contact the ME office if they have any concerns or queries.
Do MEs deal with child deaths?
Yes, MEs can review child deaths (including neonates but not stillbirths), but they should liaise with the team who already investigate all child deaths to minimise duplication and agree who will speak to the bereaved family. MEs should find out about their local Child Death Overview Panel and how ME review can fit in with the existing investigation.
Should MEs be involved in scrutiny of faith deaths if it causes delays?
MEs should scrutinise all deaths, including those of members of faith communities. ME offices should have a mechanism for identifying and prioritising deaths where rapid certification and release of the body is desirable. With appropriate prioritisation, there is no reason why ME involvement should cause a delay in these processes. Lead MEs are advised to work with their local chaplains and faith community leaders to ensure that the ME service meets the needs of the local community.
Should MEs deal with deaths out of hours?
The majority of ME work is done during office hours during the working week, but consideration should be given to how emergencies are dealt with out of hours. A formal on call rota is unlikely to be required.
How should medical examiner case review be recorded?
Each organisation will have an existing data collection system for all deaths, and MEs can either add to this or develop their own. The ME e-learning includes sample forms for recording the outcome of MEO and ME scrutiny, including a record of the conversation with the attending doctor and family. The quarterly return spreadsheets indicate what information is required for reimbursement. NHS Business Services Authority (NHSBSA) is developing a digital system for the medical examiner system. Rollout is anticipated during 2021/22 and communications to support this will be issued to enable medical examiner officers to plan local implementation.
How do I contact my Regional ME or MEO?