Contents
Information for professionals
The Medical Examiner Service for Bristol, North Somerset and South Gloucestershire provides an independent review of all deaths that are not investigated by the coroner. Scrutiny will be undertaken by a Medical Examiner, who is a senior doctor (at least 5 years post registration), normally a consultant or a GP, with additional training in death certification and the review of documented circumstances of death.
They will ensure that an accurate cause of death is recorded, identify any concerns surrounding the death itself which can then be further investigated by the care provider or coroner if required, and take the views of the bereaved into consideration.
Scrutiny consists of:
- Reviewing the medical records and any supporting diagnostic information
- Agreeing the attending practitioner’s proposed cause of death and the overall accuracy of the Medical Certificate of Cause of Death
- Discussing the cause of death with the next of kin/informant and establishing if they have any concerns with care that could have impacted or led to death, and take the views of the bereaved into consideration.
Where concerns are identified, the Medical Examiner Service will:
- Inform clinical governance systems to highlight deceased patients who may require further review by the care provider so any formal learning can be identified
- Ensure that patterns and concerns about the care received are raised appropriately
- Notify the coroner in cases where the duty to notify the coroner arises, and have not already been referred.
What does Medical Examiner Service look like?
The Medical Examiner Service in Bristol, North Somerset and South Gloucestershire has four regional offices:
- North Bristol Trust (covering deaths in Southmead Hospital)
- United Hospitals Bristol and Weston (Bristol) (covering deaths in Bristol Royal Infirmary/Bristol Haematology and Oncology Centre/Bristol Heart Institute/Bristol Royal Hospital for Children/St Michael’s Hospital)
- United Hospitals Bristol and Weston (Weston) (covering deaths in Weston General Hospital)
- Frenchay (covering deaths in all non-acute trust locations including hospices, Sirona care & health inpatient rehabilitation units, Avon and Wiltshire Mental Health Partnership, Ministry of Defence and private homes.
Each service has a team of Medical Examiner Officers who gather all the relevant information on a person’s death from reviewing the clinical notes, from the referral provided by the attending practitioner, and from discussions with the bereaved.
A Medical Examiner then performs a proportionate scrutiny of this information, ensuring that all deaths receive the same scrutiny wherever they occur and whoever undertakes the process.
From this scrutiny process the Medical Examiner is able to:
- Provide advice to the Attending Practitioner relating to the cause of death to record on the Medical Certificate of the Cause of Death
- Identify any concerns that may need further investigation, either by a coroner or by the organisation that provided care to the deceased
- Answer questions that the next of kin may have about either the cause of death or the care surrounding it.
If there are any issues that come to light during discussion with the relatives, there are several avenues that can be followed:
- If the family have minor concerns, these can be notified to the clinical team directly to address informally
- If the relatives have more serious concerns, they will be signposted to more formal avenues, for example the Patient Advice and Liaison service in the hospital, or the organisation’s formal complaint process
- All concerns raised will be escalated by the Medical Examiner Service via the organisation’s existing clinical governance processes (for example, a GP Practice Manager or hospital Mortality Review team).
How long does the process take?
Based on the scrutiny process the Medical Examiner will agree a cause of death with the doctor who has been involved in the care of the person who has died (the Attending Practitioner) to allow the death to be registered with the Register Office.
Typically the Medical Examiner’s scrutiny process will take between 1 and 3 working days from notification of the death, but it cannot delay registration beyond any legal requirements (5 calendar days from the completion and signoff of Medical Examiner review) and will not delay the release of a body where religious or cultural beliefs require it. In these circumstances there is a system in place to prioritise certain cases for fast track review.
In a small minority of cases it may not be possible to meet this timeframe, but every effort will be made to ensure that any delay is kept as short as possible and that the requirements of the faith and the bereaved are met.
How is the service accessed?
Acute hospital-based Attending Practitioners will be contacted by the hospital Bereavement team to arrange an appointment with the Medical Examiner, where a discussion can be had in person before the MCCD is completed.
Community-based Attending Practitioners will refer to the Medical Examiner Service via EMIS, having completed the “GP Referral to ME Service” referral template and sending an admin note (GP/Hospice) or email (Sirona). Specialist units such as MoD and AWP have a bespoke route of access which has been agreed in advance.
Further information for primary care can be found on Remedy.
Usual Hours of Operation
- Southmead Hospital Monday to Friday, 9am to 5pm
- Bristol Royal Infirmary Monday to Friday, 9am to 5pm
- Weston General Hospital Monday to Thursday, 9am to 4pm
- Frenchay (non-acute) Monday to Friday 8:30am to 4:30pm
Please note that these are normal hours of operation and may be subject to change.
The Medical Examiner Service operates a telephone out-of-hours service on weekends and bank holidays, 7:30am to 6pm: 0117 414 1531.
This is for cases that require urgent MCCD completion for religious and cultural reasons, where the deceased is to be buried over the weekend or bank holiday period, and paediatric repatriations out of Bristol, North Somerset and South Gloucestershire only.
Roles within the Medical Examiner Service
Lead Medical Examiner for Bristol, North Somerset and South Gloucestershire: Dr David Crossley
The Lead Medical Examiner provides leadership and guidance to ensure that the Medical Examiner Service for Bristol, North Somerset and South Gloucestershire is set up and governed effectively, and also provides leadership and support to Medical Examiners who are employed in Bristol, North Somerset and South Gloucestershire, including providing them with an independent professional line of accountability.
The Lead Medical Examiner supports the National Medical Examiner, who has an England and Wales remit, by ensuring that relevant legislation, guidance and standards are understood and implemented effectively and by keeping them informed of progress and issues arising.
Medical Examiners: Various
Medical Examiners are appropriately trained senior doctors who will undertake an independent scrutiny of deaths in order to establish an accurate cause of death, and whether the circumstances surrounding that death give any cause for concern that requires further investigation. This may be by an individual care organisation itself or by HM Coroner.
Medical Examiners are typically doctors from a range of disciplines, who are employed to provide a given number of sessions to the service rather than doctors whose only employment is with the Medical Examiner Service. This is because the knowledge and experience that they are able to provide is often enhanced by their wider remit. The number of sessions per week that each Medical Examiner provides depends on individual circumstances.
Lead Medical Examiner Officer: Charlotte Clews
The Lead Medical Examiner Officer provides support to the Lead Medical Examiner for Bristol, North Somerset and South Gloucestershire in establishing and maintaining a high-quality Medical Examiner Service.
As the professional lead for Medical Examiner Officers working in Bristol, North Somerset and South Gloucestershire, the Lead Medical Examiner Officer provides both strategic planning and operational management of the service to operate effectively and efficiently.
The Lead Medical Examiner Officer is responsible for assuring the quality of Medical Examiner Officer work and will be the main source of advice and guidance on the service for key partners, including Coroner’s Offices, Registration Service Offices, Bereavement Services and local care teams/organisations.
Medical Examiner Officers: Various
Medical Examiner Officers support Medical Examiners in their role in scrutinising the circumstances and causes of death by ensuring that the appropriate information is available to the Medical Examiner.
The Medical Examiner Officers establish the circumstances of individual deaths by performing a preliminary review of medical records to identify clinical and circumstantial information, and sourcing additional details where required. They may also assist with, under delegated authority from a Medical Examiner, two aspects of the scrutiny process: the discussion with the attending practitioner, and the discussion with the bereaved to establish if they have any concerns or questions about the death of their loved one.