Intended for healthcare professionals


Impact of the new medical examiner role on patient safety

BMJ 2018; 363 doi: (Published 14 December 2018) Cite this as: BMJ 2018;363:k5166

Linked editorial

Death certification reform in England

  1. Alan Fletcher, medical examiner and consultant in emergency medicine1,
  2. Joanne Coster, research fellow2,
  3. Steve Goodacre, professor of emergency medicine2
  1. 1Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2School of Health and Related Research, University of Sheffield, Regent Street, Sheffield S1 4DA, UK
  1. Corresponding author: S Goodacre s.goodacre{at}

Alan Fletcher and colleagues outline how the new medical examiner system could create a world leading mortality review system if implemented appropriately

The current death certification system in England and Wales has not changed in over 50 years (box 1). The government recently announced its intention to introduce a system of medical examiners that, from April 2019, will deliver a more comprehensive system of assurances for all deaths not referred to the coroner in England and Wales.1 This provides an unprecedented opportunity to develop a system that tackles concerns about avoidable hospital deaths, that works in partnership with families and carers, and that identifies deaths due to problems in care. We draw on our experience and ongoing research to describe the new role of medical examiner and how it could improve patient safety.

Box 1

Current system for examining deaths in England and Wales

A registered medical practitioner who has attended the dead person before death must complete a medical certificate of cause of death (MCCD) to the best of their knowledge and belief. If the cause of death is unknown or the death is thought to be unnatural in any way, the death must be referred to a coroner, who is an independent judicial officer with legislated powers. There is no second check of the cause or circumstances of death unless the body is to be cremated. The National Mortality Case Record Review programme aims to introduce a standardised method for reviewing case records of adults who have died in acute general hospitals in England and Scotland, but this detailed review is likely to be feasible for only a proportion of hospital deaths.


What is a medical examiner?

The role of medical examiner was developed from recommendations in the 2003 Home Office Fundamental Review of Death Certification and Investigation2 and in response to concerns raised by Janet Smith in the third report of …

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