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. This letter stated 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 have applied measures to extend medical examiner scrutiny of non-coronial deaths across all non-acute sectors 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 to scrutinise the cause of death proposed by the responsible medical practitioner 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 Structured API to support medical examiner access to a Patient’s GP Clinical record.

Outline Plan

• Specification changes for Stage 2 socialised with providers during Medical Examiner - Stage 1

• Providers to complete development of the Stage 2 changes within 3 months of the completion of Stage 1, expected start date no later than 31st October 2023

• Supplier Solutions must be fully compliant with this specification by the Effective Date

• DHSC/BSA/NHSD to complete planning to roll-out the Stage 2 changes across the respective provider estates, expected full roll-outs to complete no later than 31st March 2024

Summary of Change

Note: this Roadmap Item is relevant to the Access Record Structured API changes only. For more information on the delivery of the Access Record HTML changes please refer to Roadmap Item Medical Examiner - Stage 1

The change will allow extended access to a Patient's record after the death has been recorded by four weeks (although this timescale should be configurable in days or weeks). This will apply to the GP Connect Access Record HTML (Stage 1) and Access Record Structured API (Stage 2) to allow medical examiners access to the full Patient record. In the event the record has been de-registered, the provider must verify the record was a main Patient registration. If the record was not de-registered, access must be prevented and return a "Patient not found" error.

Details of these changes can be viewed using the following release notes:

GP Connect API 1.6.1 for Access Record Structured

Full Specification

Proposed changes can be viewed in the Summary of Change above.

Assurance Approach

The aim of clinical testing is to ensure the safe interoperability of information exported from GP systems and then processed or displayed in a consuming system. 

To help you test that your consuming system is clinically safe, we have created the following resources:

• A Patient record or, for some more complex areas, 2 records that can be requested from the GP Connect demonstrator

• A Description of each of the data items, what it is intending to test and the hazards that it is intended to mitigate

• Notes and guidance about each clinical area that describe how to process and display the data that it contains in a safe way

See Clinical test data.