Setting up a medical examiner system

This page provides information for local providers on setting up their local system including advice on establishing need and capacity, funding and recruitment. 

The development, construction and staffing of medical examiner systems will need to be managed at a local level. Initial implementations will focus on secondary care deaths, with primary care being added later in most cases. It is recommend that new services are implemented gradually and eventually built up to cover all deaths.

The below video, provided by Dr Alan Fletcher, National Medical Examiner for the NHS, provides a strong overview for providers of the key issues to consider. In discussion with Daisy Shale, Medical Examiner Officer at Sheffield Teaching Hospitals NHS Foundation Trust, Dr Fletcher explores lessons learned from pilots across the country, covering staffing, service provision and the organisation of a medical examiner service.

The National Medical Examiner has issued Good Practice Guidelines, which are essential reading for anyone setting up or running a Medical Examiner service.

Building on lessons from the pilot schemes and early adopter sites, this guidance includes information about everything you need to set up a service, from job descriptions and training to governance and working with local stakeholders.

Timelines for implementation 

NHS acute providers 

The expectation is that providers will begin to establish the size of the medical examiner system they need and start to recruit accordingly from April 2019. 

It will not be mandatory at this stage to have a fully operational medical examiner system in place – the non-statutory period allows for organisations to implement a system in a way that minimises risk. 

Community and mental health trusts

The Department of Health and Social Care (DHSC) and the Welsh Government, working with NHS Improvement and NHS Wales Shared Services Partnership, are providing the solution for medical examiners to scrutinise all non-coronial deaths including deaths in the community. The current plan is to be able to share further details about this approach at the next medical examiner information event, planned for 25 April 2019.  

National support for local medical examiner systems 

NHS Improvement has recruited Dr Alan Fletcher as National Medical Examiner who will provide professional and strategic leadership to medical examiners in their role of providing independent scrutiny and confirmation of causes of death. 

He will lead by example and set standards of best practice to improve death certification processes. He will support better safeguards for the public, monitor and improve patient safety and inform the wider learning from deaths agenda.

The National Medical Examiner is employed by NHS Improvement and will report directly to the National Director of Patient Safety. A governance structure for Wales will be through a memorandum of understanding.

What support will the National Medical Examiner have to fulfil their role?

The National Medical Examiner will be based within the NHS Improvement National Patient Safety team as such will be part of a team working on patient safety and wider mortality agendas.  It is expected that in addition to the National Medical Examiner, there will be seven regional lead medical examiners and seven regional lead medical examiner officers appointed in England.  They will be employed by NHS Improvement.  One lead medical examiner and one lead medical examiner officer will be appointed in Wales.

Funding to support providers 

The DHSC has committed to aiming to ensure the costs of running the medical examiner system cost net-neutral for providers. It is proposed that provider organisations will be reimbursed at the end of the financial year when it has become clear what their actual recruitment and set up costs are.  A flat fee is proposed for recruitment costs per post filled.

Until legislation changes, and whilst the system is in the non-statutory period, it will be funded through a combination of the fee paid for cremation form 5, and a top-up from DHSC.  Medical examiners will take on responsibility for the completion of cremation form 5, and the fee for this will be paid to the host organisation.  

When parliamentary time allows for legislation, the funding of the system will be reviewed. It will, therefore, be important to work closely with provider organisations during non-statutory implementation to ensure that there is good data around the cost of the system. 

More detail on how funding will be provided 

In future, a national digital solution will allow the medical examiner officer in the host organisation to track all the deaths scrutinised by each medical examiner, and also provide the information that host organisation finance departments need to recover the appropriate costs.

As the system is set up, the appropriate size of each medical examiner office will be determined, with initial analysis suggesting one whole time equivalent medical examiner and three whole time equivalent medical examiner officers per 3000 deaths.  This number may change as more information is gathered during implementation of the system, and a sensible size and cost can be agreed.

The DHSC will put in place a system for host providers to recoup the difference in costs for their system and the income they receive from the cremation form fees.  The exact mechanism for this is still being worked through.  The DHSC has committed to ensuring the system does not create a cost pressure.

In addition, The DHSC has agreed to provide funding to cover the costs of recruitment for setting up the system, via a flat fee / contribution per post.  The digital solution will also allow recruiting providers to evidence the number of medical examiner posts they have recruited, and then claim the funding for recruitment at year end in April 2020.

How will “reasonable” costs for operating a medical examiner system be determined?

It is anticipated that per approximately 3000 deaths, one whole time equivalent medical examiner (from a pool of varying specialities on a rota) and three whole time equivalent medical examiner officers will be a clear guide on reasonable costs.  However, this is an estimate and can be tested during the non-statutory period.  It will be recommended for organisations with significantly lower numbers of deaths to work with another local medical examiner office rather that setting up their own system.