Setting up a medical examiner service
This page provides information for local providers on setting up and running their local service including advice on establishing need and capacity, funding and recruitment. The development, construction and staffing of medical examiner systems need to be managed at a local level. Almost all acute trusts in England now have a medical examiner service. These services are being rolled out to cover deaths in the community. It is recommended that services are expanded gradually until all deaths in an area are reviewed.
The video below, provided by Dr Alan Fletcher, National Medical Examiner, provides an overview of the key issues for providers to consider. In discussion with Daisy Shale, Lead Medical Examiner Officer for Wales, Dr Fletcher explores lessons learned from pilot schemes across the country, covering staffing, service provision and the organisation of a medical examiner service.
The National Medical Examiner has issued some good practice guidelines Implementing the medical examiner system that are essential reading for anyone setting up or running a medical examiner service. Building on lessons from pilot schemes and early adopter sites, these guidelines include information about everything you need to set up a service, from job descriptions and training, to governance and working with local stakeholders.
Planning your system
Building on the Department of Health and Social Care's (DHSC) Impact Assessment, current estimates are that per 3,000 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 and 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.
Please note that a centralised bereavement service is recommended, if not already in place, and the medical examiners’ office should be located close by. The introduction of a medical examiners' office does not take away from the need for a bereavement service.
Managing out of hours requests
The intention is for a 7-day medical examiner system, including a medical examiner being available on a rota system to cover weekends but not nights. It is important to note that whilst some requests for rapid release of the deceased are made in order to proceed with a burial the same day, this cannot be guaranteed.
It is the DHSC’s understanding that some funerals must take place ‘as soon as possible’. However, whilst the medical examiner will endeavour not to introduce any delays, they must be allowed to perform equal scrutiny of the patient deaths in a way that is robust, proportionate and inclusive of next of kin/informant’s views in every respect.
Recruitment
Model job descriptions have been created by the DHSC to assist employers with recruiting medical examiners in their area. The local Coroner should be involved when planning and making medical examiner appointments. It is recognised that it may not always be practical for host organisations to include external members on interview panels. However, host organisations are encouraged to consider ways that the interview panel can include wider expertise, for example inviting a member of the organisation’s board or council of governors to take part in the interviews.
Training of medical examiners
Senior doctors intending to work as a medical examiner should undertake the required training, which includes completing 24 e-learning modules and attending a face-to-face training day.
Additional considerations
Below we list some of the additional areas identified by the established medical examiner systems across the country to help providers develop their own medical examiner services.
- A project manager should be identified to scope the creation of the new service, including the appropriate facilities, staff and costings based on the population the service is for
- Throughout, involve registration services as important stakeholders
- Do not try to include all deaths at the start; learn and refine your system
- Recruit a lead medical examiner and lead medical examiner officer initially and test the system
- Appropriate IT infrastructure should be put in place to review patient records and collate data for the national medical examiners records system
- The continuity of the service must be considered to allow the service to be delivered to the standard for case conclusion (eg 24hrs from having received a non-coroner case into the office)
- It is recommended that the medical examiner system is used to identify cases for Structured Judgement Review
- Ensure medical examiners and medical examiners officers are provided a quiet and confidential space for discussions with family and attending doctors.