Providing access to deceased patient records for MEs and coroners

Use case initially raised by Ian Anderson, Director of Legal Services and Partnerships at Hull City Council.

This relates to coroners/medical examiners being able to access information from GP and hospital systems to certify death.

We have consulted the IG lead within HNY who has indicated that the IG aspects for deceased patient records being accessed by MEs is currently covered by s251 until they become a statutory function.

The requirement would include resolution of the following dependencies, the first three of which are external dependencies:

• A decision from NHSE to enable access to GP Connect records for deceased patients.

• The necessary changes to processes and death protocols within GP systems

• A gap analysis of data in GP Connect and from other providers vs data required by MEs and coroners

• Application of suitable RBAC to control who has access to these records

Requirement outlined by Hull CC:

The medical examiner/coroner hospital and community system change. This has already been introduced in hospitals for the certification of death and is intended to move into the community from April. Unfortunately practice at hospitals is not meeting the required standards and this is likely to worsen in communities. Death certification submitted is not in acceptable to the Coroner as causes of death are unclear, incorrectly described, or simply wrong. This has had the impact that bodies are unable to be progressed to cremation, autopsies are delayed and the mortuary is blocked. We have had to expand the mortuary to deal with the delays. The hospital was funded to provide this service, however, practice has been that doctors undertaking this service frequently change and spend little time on it. In addition, GPs are not seeing patients in the community, or more importantly care homes, and therefore cannot certify death. It is acceptable for a GP to certify death where they have seen a patient – even virtually – within 28 days of the death, but not otherwise. The reduction of GP visits to Care homes and limited use of video links is anticipated to create greater challenge without a shared programme to address this. We have had situations where the Bereavement manager has attended hospital to chase down a doctor to get a death certified correctly on the day of the funeral and other occasions where the funeral has been delayed. The Medical Examiner needs access to the GP records and hospital records in a form that they can use to certify death correctly. Ideally GPs see patients, at least virtually on a monthly basis. The inexperience of those asked by the hospital to fulfil the role of ME is a major problem. There have been many calls to the Coroner’s staff to ask for advice on completing the forms/cause of death. When this passes into the community, with the limited capacity of GPs to answer calls, in the next couple of months there is significant concern that the situation will become even worse. Using the YHCR to present the information needed to the medical examiner with guidance on completing the new certificates will help prevent an immediate problem becoming a crisis. Given this is a national problem that is being taken up with the Chief Registrar and the Chief Coroner, developing a model locally now has significant potential.