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Death certification in Scotland

The system for death certification in Scotland changed on 13 May 2015.

The move comes in response to an extensive review of the system and the Certification of Death (Scotland) Act 2011, which was introduced to:

  • create a single system of independent, effective scrutiny for deaths that do not require a PF (Procurator Fiscal) investigation
  • improve the quality and accuracy of MCCDs (medical certificates of cause of death)
  • provide improved public health information
  • strengthen clinical governance in relation to deaths, through links between the new review system and health boards
  • Key changes

    • A more equally applied system i.e. same level of scrutiny of cause of death regardless of whether burial, cremation or any other form of disposal.
    • Cessation of statutory cremation forms B and C, with abolition of associated fees
    • The end of the statutory role of Crematoria Medical Referees
    • The establishment of independent Medical Reviewers, who will review a random sample of MCCDs (excluding those deaths reported to the Procurator Fiscal (PF) and Stillbirths (SB)
    • Statutory provision of information and clinical records to Medical Reviewers (MRs) by certifying doctors and Health Boards to allow the MRs to undertake the scrutiny function
    • A new stillbirth certificate (Form 6)
    • New Forms 8, 11 and 14 to include additional information such as about hazards
    • Authorisation of disposal of repatriated bodies by MRs, by burial, cremation or other methods (currently cremation authorised by Scottish Government
  • The new system

    For deaths occurring from 13 May, the completion of cremation certificates ceases completely and the new review system begins.

    Certifying doctors will increasingly be able to complete the new MCCD electronically via NHS systems.

    This will be provided in the first instance to GP practices and, thereafter, will be rolled out across the wider NHS and independent hospitals and hospices. Electronic completion should reduce avoidable errors in the content of the MCCD, as well as the workload for certifying doctors e.g. as much as possible of the patient information will be automatically populated.

    Importantly, although the MCCD will be completed electronically, a paper copy of the MCCD will still require to be printed off and provided to the next of kin.

    This will continue to be the case until the relevant legislation has been updated and amending the requirement for National Records of Scotland to receive a signed, paper copy of the death certificate.

    For doctors working in primary care, the electronic version will be accessed via the Scottish Care Information Gateway. Locums who don't have access to the gateway could opt to dictate the details for secretarial staff to enter on the eMCCD.

    The new system of level 1 and 2 reviews for scrutiny of deaths will be led by the senior MR (medical reviewer) and assisted by Medical Reviewers (MRs).

    Certifying doctors (or a clinical member of the team with knowledge of the patient and/or access to the clinical records), must make themselves available to discuss a death with the MR, but it is recognised that doctors' time is often constrained and MRs should try to accommodate working patterns. 

    Reviews of MCCDs will be random, with the randomisation process starting either when the eMCCD is submitted or when the paper version is taken to the registrar. Reviews can also be requested by 'interested persons' e.g. relatives or carers.

    The rules for PF notifications of deaths will be unchanged.

    Level 1 reviews

    It is proposed that 10 per cent of all MCCDs (approximately 5,000 per annum) will undergo a level 1 review, with a timescale for completion of one working day. The MR will look at the MCCD and speak to the certifying doctor on the phone for around five minutes. They may also speak with other members of the practice team if they have access to patient records.

    Level 2 reviews

    Approximately 2 per cent of all MCCDs will undergo a level 2 review. This is a comprehensive review with a target of three working days for completion. It will involve a level 1 review plus examination of available patient records such as eKIS, PCS, ECS and clinical portal. The MR may ask the GP practice to send off a null SCI Gateway referral for the past medical history. They will strive to ask only for electronic records to avoid transporting paper records.

    The criteria for referral to the PF remain the same. If any review finds that a case should have been referred then that case will be passed to the PF. The status of the original MCCD will be determined by the PF.

    Out of hours guidance

    Separate guidance has been issued for the provision of MCCDs out of hours (at weekends and public holidays) in exceptional circumstances where there is a requirement for a quick burial, for example, for faith and cultural reasons – (DL (2015) 8).

    Rapid Provision of MCCDs in exceptional circumstances

  • Resources

    NHS Education for Scotland have produced helpful education and learning resources
    Certification of death learning resources

    Health Improvement Scotland has published full information about the review service
    Death certification in Scotland

    Scottish Government public information
    Death Certification - Resources