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.

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.

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. 

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. 

Please note: a centralised bereavement service is recommended, if not already in place, and the medical examiners’ office should located close by. The introduction of a medical examiners office does not take away from the need for a bereavement service.