BRIEFING: Changes in death certification in Scotland

By Barry Parker, medical adviser, MDDUS 

DOCTORS in Scotland will be aware that a new Medical Certificate of Cause of Death (MCCD) was introduced in August 2014 in preparation for significant changes required by the implementation of the Certification of Death (Scotland) Act 2011.

The new certificates require additional details such as CHI number, health board area, doctor’s phone contact number and information on potential hazards such as cardiac pacemakers or radioactive material. Cremation forms are still in use at present and have not changed.

Full implementation of the Act is currently expected to take place on 13 May 2015, and there will be a number of important changes to the way in which death certification processes are carried out. Firstly, there will no longer be cremation forms and crematoria medical referees, and the certification process will be the same for both burials and cremations. There will be a new review system introduced and run by Health Improvement Scotland to review the quality and accuracy of MCCD completion.

Ten per cent of MCCDs will be randomly selected to be reviewed by a medical reviewer, a newly created post, and the review will take the form of an inspection of the MCCD and discussion with the certifying doctor. This is described as a Level 1 review.

In addition, a small number of MCCDs will be specifically selected for a more detailed Level 2 review, which will involve the medical reviewer inspecting the MCCD, discussing with the certifying doctor and accessing certain medical records. There will be several medical reviewers appointed across Scotland, and a single senior medical reviewer. In total it is estimated that around 6,000 certificates will be reviewed each year.

In the event that amendments are suggested by the medical reviewer, an amended certificate may be produced by the certifying doctor. Should there be any disagreement, the matter will be referred to the senior medical reviewer for further discussion. It is anticipated that agreement will be reached in the majority of cases. A flow chart of the full review process can be found on the Scottish Government website at http://tinyurl.com/kba4yuq

It is hoped that the new review system will not result in any significant delay for families keen to progress with funeral arrangements. Level 1 reviews are expected to be completed within one working day, and Level 2 reviews within three working days. Families may request an expedited procedure in certain circumstances where required for burial/cremation arrangements.

It is important to emphasise that the guidance available for how the cause of death itself is described on death certificates has not changed, and this guidance is available at http://tinyurl.com/qxyxojw. Furthermore, there is no change to the arrangements for reporting deaths to the Procurator Fiscal (http://tinyurl.com/lhtd5b6). Doctors may be able to discuss certain aspects of certification with medical reviewers, but if contemplation is being given to reporting the death to the PF, then a direct approach to the PF office is still required to obtain advice on this.

One final change will be the introduction of electronic MCCD forms. This will be rolled out to GP practices from May 2015 onwards, and then to other healthcare settings. This may facilitate completion, but there will still be a requirement to print off the completed form to be signed and passed to the representative of the deceased in the usual way.