Recommendation 279

Responsibility for certifying the cause of death

So far as is practicable, the responsibility for certifying the cause of death should be undertaken and fulfilled by the consultant, or another senior and fully qualified clinician in charge of a patient’s case or treatment.

Existing guidance that is provided with medical certificates of cause of death states that death certification should be completed by a consultant or senior clinician, although this could be delegated to a junior doctor who was in attendance but only where they are closely supervised. This advice will be retained in the new guidance issued by the Chief Medical Officer to accompany the new set of medical certificates of cause of death.

The Department of Health intends to publish draft death certification regulations that states that an attending practitioner is a registered medical practitioner who:

attended the deceased in the last 28 days for the condition or disease that caused their death, or

is a partner or employee of the same general practice as the attending practitioner and has attended the deceased within the last 12 months for the disease or condition that caused their death.

To support those certifying the cause of death the Chief Medical Officer will issue guidance on how death certification forms are completed in 2014 that will replace existing guidance, and medical examiners will support doctors completing medical certificates of cause of death  to ensure that they are consistent and of sufficient quality and may recommend further training where that is deemed necessary.


A number of the recommendations in Sir Robert’s Mid Staffordshire Inquiry report refer to our planned reform of the death certification system and the introduction of the role of medical examiner in England and Wales. A new system of medical examiners has been trialled successfully in a number of areas across the country. The work of the two flagship sites in Gloucestershire and Sheffield has been continued and extended to operate a medical examiner service on a city and countywide basis at a scale that will be required for implementation by local authorities when legislation is introduced. We will publish shortly a report from the interim National Medical Examiner setting out the lessons learned from the pilot sites.

The government remains totally committed to the principle of these reforms. Further progress will be informed by a reconsideration of the detail of the new system in the light of other positive developments on patient safety since 2010 and by a subsequent public consultation exercise.