The BMA has written to the Essex Chief Coroner asking them to withdraw incorrect guidance to local GPs around the verification of deaths in the region, ahead of possible legal action.
The Essex Chief Coroner wrote to local GPs at the end of April1, instructing them that it was only acceptable for healthcare workers to verify expected deaths, and that this must take place in person.
BMA lawyers have now written to the Essex Chief Coroner outlining that this direction is contrary to English law, which states that any competent adult can verify a death, and that it is not supported by joint guidance from the BMA and the Royal College of GPs2, as well as separate guidance from NHS England/Improvement3.
Demanding that healthcare workers attend deceased patients to verify deaths not only takes staff away from direct patient care unnecessarily at a time when they are most needed, but it also puts both staff and other people at risk by potentially exposing them to Covid-19, the BMA says.
The letter from the BMA also states that the coroner has no legal jurisdiction over verification of death – or the confirmation that someone has sadly died. This is separate to the process of death certification, in which the cause of death is recorded.
This is most recently supported by the Ministry of Justice4, which confirmed that coroners have “no legal powers, authority or mandate concerning the verification of death”.
The BMA is asking that the Essex Chief Coroner clarifies the legal basis for their direction, and if a suitable response is not received in good time, the BMA will consider legal action in the form of a judicial review.
The BMA is taking this action in support of, and with the full knowledge, help and assistance of, the Essex Local Medical Committees5.
Dr Mark Sanford-Wood, BMA GP committee deputy chair, said:
“The process of verifying a death must be swift, pragmatic and have the emotional wellbeing of those close to the deceased at its heart. This is all the more important during the current health crisis, which has already proved devastating for so many.
“For years GPs and their local coroners have had positive relationships whereby they have worked together to reach agreement over processes that ensure a sensible and sensitive approach to certifying deaths. Therefore, it’s incredibly disappointing to see coroners during this pandemic taking it upon themselves to put themselves ahead of the law, making unrealistic and unsafe demands.
“The law and all available guidance are clear on who can verify a death and that physical attendance by a GP is not necessary – and in practice, where suitable, it is often done over the telephone in conjunction with other health professionals, care home staff or funeral directors.
“To demand that GPs attend in person takes them away from frontline care – and crucially puts them at risk if the patient has died from Covid-19 related illness.
“Such a direction also complicates and slows down the verification process – potentially increasing distress for patients’ families at what is already an incredibly difficult time.”
Dr Victoria Tzortziou-Brown, joint Honorary Secretary of the Royal College of GPs, which is named as an interested party in the letter, said:
“During the COVID-19 pandemic the processes in relation to death registration and management across the UK have been changing to ensure the deceased are treated with the utmost respect, to help minimise delays and distress for bereaved families and to protect public health. In these extraordinary times, there is a need for various groups of workers to work differently and together as one system.
“This is why in collaboration with the BMA we have produced guidance for the verification of expected death with the remote assistance of other workers so that the verification process can be completed by a clinician safely ensuring that bereaved families do not experience needless delays, reducing the risk of unnecessary exposure to the virus and allowing clinicians to continue on the front line.”
Notes to editors
The BMA is a trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.
- The Essex Chief Coroner wrote to Essex LMC and local trusts on 29 April. The email stated: “It is not acceptable under my jurisdiction, that the verification of death is carried out by video. Only a Health Care Professional (Doctor, Paramedic or Registered Nurse) may verify the death and this must be in person. It is not acceptable for death to be verified by anyone else.”
- BMA guidance, including best practice protocol produced in conjunction with the Royal College of General Practitioners, available here.
- NHS England guidance is available here and DHSC guidance here.
- See ‘Coroners have no right to tell GPs they must verify death in person, says MOJ’ (Pulse, 13 May 2020).
- For information on Essex LMCs see their website.