Background

In June 2021 a letter was sent to all NHS Acute Trusts (from the National Medical Examiner, the National Director for Patient Safety and Deputy Chief Medical Officer, the National Medical Director and the Medical Director for Primary Care) that set out what local health systems needed to do to implement the national medical examiner system for scrutiny of non-coronial deaths across all health settings. The letter can be viewed here:

NHS England » System letter: Extending medical examiner scrutiny to non-acute settings

Medical examiner offices should be putting measures in place to extend medical examiner scrutiny of non-coronial deaths across all non-acute sectors as early as possible in 2021/22, so that all deaths are scrutinised by the end of March 2022.

Medical examiners will introduce a level of independent scrutiny improving the quality and accuracy of the medical certificate of cause of death, and thereby informing the national data on mortality and patient safety.  Medical examiners will increase transparency and offer the bereaved the opportunity to raise concerns. It will provide new levels of scrutiny to help identify and deter criminal activity and poor practice.  Currently, the process for burials does not include scrutiny of the medical certificate of cause of death.  As a result of the introduction of the medical examiner system, all deaths would be scrutinised by either a medical examiner or coroner, irrespective of the decision to bury or cremate, thus bringing the system onto an equal footing.   

The Coroners and Justice Act 2009 set out the statutory system for medical examiners. The Health and Care Bill 2021 will amend the statutory medical examiner system in the Coroners and Justice Act 2009 so that NHS bodies may appoint medical examiners to scrutinise all deaths which do not involve a coroner, rather than local authorities.

In order for medical examiners (who are senior doctors) to scrutinise the cause of death proposed by the responsible medical practitioner (the medical practitioner responsible for the patient before they died) the medical examiner requires access to patient records. This is already achieved in hospital settings as all medical examiner offices are based in NHS acute trusts, and therefore have access to relevant records in hospital settings. However this is not yet possible across other care settings, and so changes are being implemented to GP Connect: Access Record and Access Document to support Medical Examiner access to a patient’s GP Clinical record.

Outline Plan

• Socialise spec changes with Providers by 4^th May
• Providers to complete development of the changes within 3 months of the roadmap publication date
• DHSC/BSA/NHSD to complete planning to roll-out the changes across the respective Provider estates, expected full roll-outs to complete no later than 31^st August

Summary of Change

The ask of the GP digital providers is that a period for which a patient’s record is available to view via GP Connect: after death is implemented to extended access by a period of four weeks (although this timescale should be configurable in days or weeks). This will also apply to the GP Connect: HTML, Access Record Structured and Access Document capability to allow medical examiners access to the full patient record. The provider must verify the record was a main patient registration in the event the record has been de-registered and prevent access if it was not and return a patient not found error.

Note: this Roadmap Item is relevant to the HTML changes only. The delivery of the Access Record Structured and Access Document changes will be delivered as part of Stage 2.

Full Specification

Uplifted Standard:

GP Connect v5.0.0

The changes can be viewed using the following Netlify links:

https://developer.nhs.uk/apis/gpconnect-0-7-4/

The release notes contains links to the pages which have been updated.

Assurance Approach

Assurance of the GP Connect Provider suppliers for the Medical Examiners change will be a hybrid approach consisting of assuring supplier’s test evidence of successful API testing of the supplier system with the uplifted NHS Digital SA automated Provider Test pack for Access Record HTML, complemented with review of any additional test evidence ‘asks’ through supplier system demonstration and/or supplier system screenshots. High level test scenarios for assurance will be provided by NHS Digital SA team.

Assurance of GP Connect Consumer Suppliers for the Medical Examiners change will be through the Supplier Conformance Assessment List (SCAL) process.

For any queries, Suppliers can reach out to functional.assurance@nhs.net