Running a medical examiner System
Planning your system
Building on the DHSC’s Impact Assessment, current estimates are that per 3000 patient deaths, the system will require:
- one whole time equivalent medical examiner (from a pool on a rota basis based on 10 programmed activities per week)
- three whole time equivalent medical examiner officers.
Of course, the set up must be reflective of the case mix, geography and may necessitate variation based upon the demographics of the population covered. Organisations with significantly lower numbers of deaths are recommended to work with another local medical examiner office rather than setting up their own system.
It is expected that the site with the largest number of deaths will host the principal medical examiner office within the host organisation. It is expected that medical examiners and medical examiner officers will also work from other hospital sites within the host organisation as necessary – there is no reason why medical examiners cannot share offices across sites.
Managing out of hours requests
The intention is for a seven-day medical examiner system, including a medical examiner being available on a rota system to cover weekends but not nights. It is important to note that whilst some requests for rapid release of the deceased are made in order to proceed with a burial the same day, this cannot be guaranteed.
It is the DHSC’s understanding that funerals must take place ‘as soon as possible’. However, whilst the medical examiner will endeavour not to introduce any perceived delays, they must be allowed to perform equal scrutiny of the patient deaths in a way that is robust, proportionate and inclusive of next of kin/informant’s views in every respect.
Staffing for busier periods
During the week, additional staffing/hours should be considered for Mondays as it is the busiest day for the service.
The staffing estimates should allow for an average spread across the year, based on retrospective data. However, the unpredictable nature of patient deaths is a legitimate consideration and only when numerous medical examiner offices are running will this be fully tested.
The following model job descriptions have been created by the Department for Health and Social Care to assist employers with recruiting medical examiners in their area.
The local Coroner should be involved when planning and making medical examiner appointments.
It is recognised that it may not always be practical for host organisations to include external members on interview panels. However, host organisations are encouraged to consider ways that the interview panel can include wider expertise, for example inviting a member of the organisation’s board or council of governors (in the case of NHS Foundation Trusts) to take part in the interviews.
Training of Medical Examiners
Senior doctors intending to work as a Medical Examiner should undertake the required training, which includes completing 26 e-learning modules and attending a face-to-face training day. More details about the training are available on the Medical Examiner Training page.
Issues of confidentiality will be handled in the same way as they are now. If the condition contributed to death then it must be written on the medical certificate cause of death. Best practice would dictate that these rare situations should be handled by both the patient’s consultant and the medical examiner office with sensitivity and compassion.
Below we list some of the additional areas identified by the pilot medical examiner systems across the country, to help providers develop their own medical examiner services.
- A project manager should be identified to scope the creation of the new service including the appropriate facilities, staff and costings based on the population the service is for.
- Throughout, involve registration services as important stakeholders.
- Do not try to include all deaths at the start; learn and refine your system.
- Recruit a Lead Medical Examiner and Lead Medical Examiner Officer initially and test the system.
- Appropriate IT infrastructure should be put in place to review patient records and collate data for the national medical examiners records system. The Department of Health and Social Care is developing a national digital system for data entry.
- The continuity of the service must be considered to allow the service to be delivered to the standard for case conclusion (eg 24hrs from having received a non-coroner case into the office).
- It is recommended that the medical examiner system is used to identify cases for Structured Judgement Review.
- Ensure medical examiners and medical examiners officers are provided a quiet and confidential space for discussions with family and attending doctors.
Good Practice Series
The Good Practice Series is a topical collection of focused summary documents, designed to be easily read and digested by busy front-line staff, with links to further reading, guidance and support.
It is a privilege to lead the new specialty of medical examiners. Once again, I am delighted to have the Royal College of Pathologists' support in promoting good practice. The Good Practice Series will ensure consistency and high standards are maintained and each instalment has the benefit of subject matter expert input. I hope the resource will be of value outside the medical examiner office as well.
Dr Alan Fletcher, National Medical Examiner
Good Practice Series No. 1