COVID-19: death certification and cremation

This guidance replaces existing BMA guidance on verification and certification of death and cremation during the COVID-19 outbreak.

Location: UK
Audience: All doctors
Last reviewed: 13 April 2022
COVID virus illustration

Death certification and cremation forms

The Coronavirus Act 2020, which introduced easements to death certification processes and cremation forms during the pandemic, was repealed on 24 March 2022.

The following provisions are continuing:

  • if a doctor has not seen the deceased in the 28 days prior to death or any time after death they can complete the MCCD (medical certificate of cause of death), however the registrar would need to refer the MCCD to the coroner. This time period will remain at 28 days and not revert to pre-pandemic 14 days
  • ability for medical practitioners to send MCCDs to registrars electronically
  • the form Cremation 5, which was suspended during the pandemic, will not be re-introduced after the Coronavirus Act expires and has now permanently been abolished

The following emergency provisions are changing with the expiry of the Act:

  • the temporary provision allowing any medical practitioner to complete the MCCD will be discontinued
  • informants will have to register deaths in person, not remotely.

The Cremation Regulations (2008) does not state any time frame in which a doctor has to have attended the deceased before or after death to complete Form 4. If a doctor completes Form 4 without having seen the deceased before or after death, the Medical Referee will make a decision about whether or not a cremation should take place.

 

In England and Wales

A new medical examiner system is being rolled-out across England and Wales, which the Government claims will provide greater scrutiny of deaths.

Acute trusts in England and local health boards in Wales were asked to set up medical examiner offices to initially focus on the certification of all deaths that occur in their own organisation on a non-statutory basis.

In February 2021, the Government published the white paper Working together to improve health and social care for all. It includes provisions for medical examiners to be put on a statutory footing.  In 2021/22, the Government asked that these extend to include all non-coronial deaths, wherever they occur.

The Ministry of Justice has confirmed that there is no requirement for form cremation 5 to be completed, as this was suspended during the period of the Coronavirus Act, and has now been permanently abolished.

Read about cremation forms and guidance on GOV.UK.

Implementation of the medical examiner system has taken place to allow time for capacity and processes to be put in place. The statutory basis for this system is likely to be introduced in mid to late 2022.

More information on the medical examiner system can be found on the NHS website or by contacting the National Medical Examiner.

 

In Scotland

The chief medical officer in Scotland wrote to directors of public health, board medical directors and primary care leads on 24 March 2020.

In the letter it outlines the key steps to be taken with regard to death certification during the pandemic.

In summary it:

  • clarifies terminology around cause of death associated with COVID-19 disease
  • clarifies that although COVID-19 is a notifiable disease, COPFS (Crown Office and Procurator Fiscal Service) do not need to be advised of COVID-19 deaths during the pandemic period
  • explains the fast track procedure for completion of the MCCD during the period of the pandemic
  • explains changes to the DCRS (death certification review service) during the period of pandemic.

 

In Northern Ireland

For Northern Ireland, the legislation to extend the death certification process under COVID has been extended until 24 Sept 2022. The chief medical officer and coroner have issued formal notifications and letters:

In summary:

  • legislation to extend the death certification process under COVID in NI has been extended until 24 Sept 2022
  • death and still births: the medical practitioner to send a copy of the certification to the registrar by electronic means and or by telephone
  • there is no need to sign the death certificate if informed by phone or electronic means
  • the Act removes the requirement in Northern Ireland that a death from natural illness or disease must be notified to the coroner if the deceased had not been seen or treated by a registered doctor within 28 days prior to the death
  • removes the need for a second confirmatory medical certificate in order for a cremation to take place in Northern Ireland.