Death Certification and Cremation Forms - do not use after 9.9.24 Obsolete

Death Certification

*********Do not use this page after 9.9.24******** Go to Death Certification and Cremation Forms - From Monday 9th September page.

The RCPath flowchart summarises the scenarios in which doctors can complete a death certificate and Cremation form 4. Only GMC registered medical practitioners (i.e. doctors) can legally sign death certificates or cremation forms. 

Electronic submission of forms are allowable and there are no plans to re-introduce cremation form 5 (part 2).

If you have not seen the patient (F2F or via video) during their last illness, then you need to refer to the coroner. Seeing the patient for the first time after death is not acceptable.

If you have seen a patient before death but more than 28 days ago, you do not need to inform the coroner if you have also seen them after death and feel able to state the cause of death.

In order to complete a death certificate and form 4 you must have:

• Attended the patient during their last illness within 28 days of death (F2F/video).
• or
• Attended (F2F/video) the patient during their last illness (but not within 28 days of death) and after death (F2F only).

For full details please see: Coronavirus Act expiry. Death certification and registration easements from 25 March 2022

Information for Next of Kin (NOK)

The death needs to be registered by the NOK in person (phone registration no longer accepted). Please advise the NOK that they need to book their appointment with the registry office by phoning or online (see contact details below). It is still a legal requirement that deaths are registered within 5 calendar days, the prompt issue of the MCCD is still important in this respect.

Bristol - The registry office requests that GP surgeries still email a copy of the death certificate to them, as this allows the staff to check there are no errors in advance of the appointment, although this is not mandatory and a paper copy of the death certificate brought by the patient to their appointment would also be acceptable. GP surgeries should make the paper death certificate available for the NOK to collect in person, as done previously. Alternatively, if the death certificate has been emailed to the Register Office, then death certificates may be sent securely in batches (at least monthly).

North Somerset & South Glos - Registration Services will ALWAYS require a scanned copy of the MCCD. Retain paper copy of MCCD for a period of 4 weeks in case of queries. After 4 weeks the paper copy can be confidentially destroyed. The new legislation enables the electronic transmission and storage of documents, it does not remove the provision for the existing paper process. Therefore, although it is still acceptable to give a paper copy of the MCCD to the next of kin, IN PRACTICE it has been proven that sending the electronic copy directly to the registration service provides a much better customer journey therefore this is the preferred option. Please also see some helpful tips on the process from South Gloucestershire register office.

Cause of Death

Please see the Cause of Death section below for further advice.

Cremation Forms

Cremation Form 4

The first part of the cremation certificate (Form 4) can now be submitted electronically (see contact details below) – sending from the secure email account of the person completing the form directly to the crematorium is considered acceptable as an electronic signature.

You may also copy in the email of the funeral director as long as they have a secure email address (note nhs.net to gov.uk is secure). Recent Ministry of Justice guidance states that unsigned emails are only acceptable if they are sent directly from the GP’s personal secure email address to the crematorium.

Cause of Death and Crem Form protocol

There is also the Cause of Death and Crem Form protocol which is embedded in EMIS. This allows GPs to record cause of death and complete a cremation form (Form 4). This can then be saved and emailed via your personal nhs.net email address (this will be taken accepted as a digital signature and removes the need to physically sign the document) directly to the local cremation authority.The Funeral Director dealing with the funeral can assist in identifying the relevant authority.

Instructions on how to upload the protocol are available here.

Alternatively a paper Form 4 can still be used and emailed or sent. There is also a downloadable version of Form 4 available below:

• Form 4 
• Guidance on completing Form 4 is available at: Medical practitioners: guidance on completing cremation forms - GOV.UK (www.gov.uk)

Cremation Form 5

The need for the second confirmatory part (Form 5) of the cremation form to be completed has been removed.

Contact Details

Registrar Offices (send Death Certificates to the relevant local office as below):

• Bristol Registrars Office:

NOK can book their appointment to register the death in person by phoning 0117 922 2800 or  on line at https://www.bristol.gov.uk/births-deaths-marriages/register-a-death  

Email address where death certificates should be sent for Bristol patients: register.office@bristol.gov.uk

• North Somerset Registrars Office:

Email address where death certificates should be sent for North Somerset patients: somersetregistrations@somerset.gov.uk

• South Glos Registrars Office:

Email address where death certificates should be sent for South Gloucestershire patients registrationservice@southglos.gov.uk  

Crematoriums

(send Form 4 to the local crematorium dealing with the cremation - please ask the funeral director if you are not sure which crematorium to send it to):

Bristol Crematorium:

Form 4 can be emailed directly to the crematorium for Bristol patients: cems.crems@bristol.gov.uk

Cause of Death

Please see some advice regards acceptable cause of death on a death certificate during COVID-19:

• COVID-19 is an acceptable direct or underlying cause of death for the purposes of completing the Medical Certificate of Cause of Death
• COVID-19 is not a reason on its own to refer a death to a coroner under the Coroners and Justice Act 2009.
• It is acceptable to qualify mention of Covid-19 with words such as ‘possibly’ or ‘probably’ indicating the absence of a positive virology test or some ambiguity in clinical presentation, and such qualifiers do not in themselves imply sufficient doubt on the cause of death to require referral to a coroner. The recording of “probable Covid-19” or “possible Covid-19” as the cause of death is not acceptable on its own. However when accompanied by an acceptable cause of death in part 1 of the MCCD it can be accepted. For example 1a Bronchopneumonia, 1b Probable COVID-19.  
• That COVID-19 is a notifiable disease under the Health Protection (Notification) Regulations 2010 does not mean referral to a coroner is required by virtue of its notifiable status.

For full guidance see Guidance for doctors completing Medical Certificates of Cause of Death  in England and Wales.

Medical Examiners

****Update - May 2024****

Scrutiny by a Medical Examiner will become a statutory requirement prior to the registration of all non-coronial deaths in England and Wales on 9^th Sep 24. After this date MCCDs that have not been subject to ME scrutiny will be rejected by the Register Office.

Please see the most recent update from the MEs Office

Once the new system is introduced, there will be a substantial change to the administration of deaths in the community. The Medical Examiner service has been reviewing deaths occurring in hospitals for several years and this new process is due to be extended to general practice.

The introduction of the Medical Examiner service is a significant change that will require GPs involved in the recording of a death to take different steps. We expect that through the creation of an EMIS F12 and an information on Remedy, this will be a successful change for all parties.

Please see the podcast produced my Avon LMC below for further information:

Avon LMC Podcasts - Understanding Changes to Death Certification: A Guide for General Practice | RSS.com 

Contact Details

Queries regarding individual cases can be directed as below:

• T: 0117 4140074
• E: nbn-tr.medicalexaminer@nhs.net

National Guidance

A new statutory medical examiner system is being rolled out across England and Wales to provide independent scrutiny of deaths, and to give bereaved people a voice. The Department of Health and Social Care (DHSC) death certification reform changes will become mandatory from April 2024. See further details below:

• NHS England » The national medical examiner system

There is also more specific guidance for primary care regarding deaths in the community:

• NHS England » Information for primary care on extending medical examiner scrutiny to non-coronial deaths in the community

Medical Examiner Offices for deaths in hospital:

• UHBW Medical Examiners Office (uhbristol.nhs.uk)
• NBT Medical Examiner Office (nbt.nhs.uk)

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.