Agenda item

[Dr Julian Parkes will be discussing the role of GPs in the community and the certification process.  Note attached].

Dr Julian Parkes GP outlined his experiences of the death certification processes.  He stated that Primary care was a list based system meaning that patients were registered with a practice and the practice took responsibility for their patients. The Alfred Squire Road Practice had 8400 registered patients.  The average GP in England was responsible for 1850 patients.  There were approximately 100 deaths per year from patients registered at the Alfred Squire Road Practice.  Deaths in Primary Practice tended to fall into four distinct categories:

1)    Sudden death where the patient had not recently been seen.

2)    Deaths in Hospital.

3)    Deaths at home but expected, the patient was often receiving palliative care for Cancer. 

4)    Deaths in Compton Hospice or following discharge from hospital to a nursing home, which was not their usual residence.

An audit of deaths in September 2017, over a three-month period, showed there had been a total of 25 deaths, 4 deaths were sudden and unexpected. The breakdown was as follows: -

·       12 deaths occurred in Accident and Emergency or as inpatients at Newcross Hospital and one at another Hospital.

·       2 deaths occurred at Compton Hospice.

·       3 deaths were in a residential or nursing home.

·       8 deaths at home, with 3 of those being sudden and unexpected, with the remaining 5 being on the Palliative Care Register and expected to die.

Dr Parkes commented that it was required by law that a Doctor notified the cause of death and not the fact of death.  The specific circumstances of the death would affect whether a GP could issue a Medical Certificate of Cause of Death (MCCD).  He outlined the circumstances where a death would have to be reported to the Coroner, as detailed in his written report which had been circulated with the agenda.   He also outlined the formal procedures required if a patient was to be cremated.

A Member of the Panel enquired if it was still permittable to write, “old age” on the Medical Certificate of Cause of Death. Dr Parkes responded that Doctors tried to avoid the use of term as much as possible, but there were certain circumstances where it was permissible to still use the term. 

Cllr Sohail Khan commented that GPs out of hours availability was vitally important.  Contacting a deceased person’s GP out of hours, from experience, he found to be problematic.  In response, Dr Parkes outlined that GPs were contracted to work from 8am - 6:30pm, five days a week, excluding bank holidays.  There were out of hours GPs or paramedics who could confirm death after the closing hours of the surgery.  Normally they would inform the family that they would need to contact the deceased person’s GP surgery during opening hours to arrange for a Medical Certificate of Cause of Death to be issued.  An appointment with the Registrar could not be made until they had the Medical Certificate of Cause of Death.  An out of hours GP would not be able to issue the Medical Certificate of Cause of Death unless they had seen the person in the last 14 days prior to death. 

Cllr Khan stated that his expertise was in Muslim burials, where there was an expectation for burial to be 12-18 hours following the death of a person in palliative care.  If a Medical Certificate of Cause of Death could not be obtained until the GP Surgery was open, then there was potentially a delay in the process, should the death happen out of hours.  The delay could be significant if it happened on a Friday evening.  Dr Parkes commented that it was an issue where religious need and the law were not connected.  There were certain circumstances such as a GP being away on holiday for two weeks, who had been looking after a patient, where they would contact the Coroner to see if they would be permitted to issue a Medical Certificate of Cause of Death.  But even this scenario would cause a delay in the process.