MEDICAL PROFESSION, ENGLAND AND WALES Part 1 General Citation, commencement, extent and application 1 1 These Regulations may be cited as the Medical Certificate of Cause of Death Regulations 2024 and come into force on 9th September 2024. 2 These Regulations extend to England and Wales. 3 These Regulations apply in relation to a death that is required to be registered under Part 2 of the 1953 Act . Interpretation 2 In these Regulations— “ the Act ” means the Coroners and Justice Act 2009; “ appropriate medical examiner ” means a medical examiner to whom the death has been allocated by an English NHS body or a Welsh NHS body, as the case may be; “ attending practitioner ” means a registered medical practitioner who attended the deceased before their death; “ attending practitioner’s certificate ” has the meaning given in regulation 3(3); “ confirmed attending practitioner’s certificate ” has the meaning given in regulation 11(3); “ English NHS body ” has the meaning set out in section 18A(4) of the Act (Medical Examiners: England) ; “ health record ” has the meaning given by section 1 of the Access to Health Records Act 1990 (“health record” and related expressions) ; “ medical examiner’s certificate ” has the meaning given in regulation 19(2); “ other relevant medical practitioner ” means a registered medical practitioner who, in relation to a death, is not a relevant attending practitioner, but has— made a notification or referral to a senior coroner under any enactment, sought advice from a medical examiner; or sought to fulfil any function under these Regulations; “ relevant attending practitioner ” means the attending practitioner who has— prepared the attending practitioner’s certificate under regulation 3(1)(b)(i), and made available such certificate to the appropriate medical examiner under regulation 3(1)(c)(i); “ relevant health records ” means health records containing information about— any disease or condition which may have led directly or indirectly to the death, or any other disease or condition which may have significantly contributed to the death; “ relevant senior coroner ”, in relation to a death, means the senior coroner appointed for the coroner area in which the body of the deceased person lies; “ Welsh NHS body ” has the meaning set out in section 18B(3) of the Act (Medical Examiners: Wales) . Part 2 Attending practitioner’s certificate Attending practitioner’s certificate 3 1 As soon as practicable after becoming aware of a death, an attending practitioner must— a review— i the deceased person’s relevant health records; ii the results of any physical examination of the body of the deceased person undertaken by the practitioner or any other registered medical practitioner; and iii any other information which the practitioner considers relevant, with a view to establishing the cause of death to the best of the practitioner’s knowledge and belief; b either— i prepare and sign an attending practitioner’s certificate; or ii where they are not able to establish the cause of death, refer the death to the relevant senior coroner; and c where they have prepared and signed an attending practitioner’s certificate, make available to an appropriate medical examiner— i the attending practitioner’s certificate; and ii the deceased person’s relevant health records and any other information reviewed under sub-paragraph (1)(a). 2 Paragraph (1) does not apply where— a another attending practitioner has given an attending practitioner’s certificate to an appropriate medical examiner in relation to the death; b the relevant senior coroner has referred the death to an appropriate medical examiner under regulation 15(1); or c the relevant senior coroner has decided that there is a duty to conduct an investigation into the death under section 1 of the Act. 3 For the purposes of these Regulations, “ attending practitioner’s certificate ” means the certificate referred to in section 20(1)(a)(i) of the Act which shall take the form of— a in the case of a death of a child within the period of 28 days beginning with the day of the child’s birth, the certificate in either of the forms set out in Part 1 or Part 2 of Schedule 1; b in the case of any other death, the certificate in either of the forms set out in Part 1 or Part 2 of Schedule 2. Attending practitioner’s referral to the relevant senior coroner 4 1 If at that time there are exceptional circumstances to justify doing so, a referral under regulation 3(1)(b)(ii) may be made orally, but otherwise must be in writing. 2 An attending practitioner who makes a referral to the relevant senior coroner orally under paragraph (1) must, as soon as practicable thereafter, confirm the referral in writing to the relevant senior coroner. 3 When making a referral under regulation 3(1)(b)(ii), or as soon as practicable thereafter, in addition to complying with the duty set out in regulation 2 of the Notification of Deaths Regulations 2019 , the attending practitioner must provide to the relevant senior coroner any information referred to in regulation 3(1)(a) not already provided to the relevant senior coroner. 4 Subject to paragraph (5), where the relevant senior coroner has— a received a referral or notification of a death under any enactment; and b decided that there is no duty under section 1 of the Act to conduct an investigation into the death, the relevant senior coroner must notify the attending practitioner of that decision and the reasons for it. 5 Paragraph (4) does not apply to a referral to the relevant senior coroner under regulations 10(1) or 20(1). 6 Where an attending practitioner receives a notification under paragraph (4), the practitioner must, as soon as practicable, comply with any duties of the practitioner under these Regulations that had not been complied with prior to the referral or notification of the death to the relevant senior coroner. Duties of medical examiner after receiving attending practitioner’s certificate 5 Regulations 6 to 13 apply where an appropriate medical examiner is provided with an attending practitioner’s certificate under regulation 3(1)(c)(i) or regulation 13(2)(b)(i) in relation to a death. Medical examiner’s scrutiny of cause of death 6 1 The appropriate medical examiner must, as soon as practicable, with a view to confirming the cause of death— a make whatever enquiries the examiner considers necessary; b take into account any conclusions drawn from any enquiries made under sub-paragraph (a) and any information provided under regulations 3(1)(c) and 13(4); and c take into account any other information which the examiner considers relevant. 2 The appropriate medical examiner must make a record of any conclusions drawn from the enquiries made and information considered in sub-paragraphs (1)(a), (b) and (c). 3 The appropriate medical examiner may undertake an external examination of the body of the deceased person, or, subject to paragraphs (4) to (7), instruct another individual to do so on their behalf, with a view to confirming the cause of death. 4 The appropriate medical examiner may only appoint another individual to undertake an external examination of the body of the deceased person for the purpose of paragraph (3) where— a in the opinion of the examiner that individual has suitable expertise; and b none of the circumstances in paragraph (5) apply. 5 The circumstances are that the individual— a is the spouse, ex-spouse, civil partner or ex-civil partner of— i the deceased person (“ D ”); ii the relevant attending practitioner (“ AP ”); or iii any other relevant medical practitioner (“ OP ”); b is, or was, living together with D, AP or OP as if they were a spouse or civil partner; c is, or was, closely related to D, AP or OP; d is or, was, a partner, employer, employee or associate of D, AP or OP; e attended D during the course of D’s last illness; f had a financial interest in D’s estate; or g has or had any other association, relationship or connection with D, AP or OP such as to give the appropriate medical examiner reasonable doubt as to the practitioner’s objectivity to carry out an external examination of D. 6 In sub-paragraph (5)(c), “ closely related ” means a parent, sister, half-sister, brother, half-brother, son, daughter, uncle, aunt, grandparent, grandchild, first cousin, nephew, niece, parent-in-law, grandchild-in-law, sister-in-law, brother-in-law, son-in-law, daughter-in-law, stepchild, step-parent, stepbrother or stepsister. 7 In paragraph (6), references to step relationships and in-laws are to be read in accordance with section 246 (interpretation of statutory references to stepchildren etc) of the Civil Partnership Act 2004 . Relevant attending practitioner’s duty to respond to medical examiner enquiries 7 1 The relevant attending practitioner must be available, as far as reasonably practicable, to respond to any enquiries that the appropriate medical examiner may have in connection with the attending practitioner’s certificate. 2 The appropriate medical examiner must make a record of— a the relevant attending practitioner’s response to any enquiries made under paragraph (1); and b any discussions that take place between the examiner and the relevant attending practitioner in relation to the attending practitioner’s certificate. Medical examiner’s duty to discuss the cause of death 8 1 The appropriate medical examiner, or someone acting on behalf of the examiner, must, as soon as practicable— a take reasonable steps to discuss the cause of death with a person who is qualified to give information concerning the death under sections 16(2) or 17(2) of the 1953 Act or any other person whom the examiner considers appropriate; b offer a person mentioned in sub-paragraph (a) an opportunity to raise any matter which might cause the relevant senior coroner to think that there is a duty to investigate the death under section 1 of the Act; and c make a summary record of any discussion under sub-paragraphs (a) or (b) and its outcome. 2 Paragraph (1) does not apply where, in the case of a death for which a revised attending practitioner’s certificate has been completed under regulation 13(2)(a), the appropriate medical examiner or someone acting on their behalf has previously complied with the requirements of paragraph (1) in relation to the death. Medical examiner’s confirmation of cause of death 9 1 Paragraph (2) applies where, after complying with regulations 6 and 8 in relation to a death, the appropriate medical examiner is satisfied that— a the cause of death stated on the attending practitioner’s certificate relating to the death is accurate; and b that certificate is duly completed. 2 The appropriate medical examiner must, as soon as practicable, confirm the cause of death as stated on the attending practitioner’s certificate by signing that certificate (“confirmed attending practitioner’s certificate”). Medical examiner’s referral to the relevant senior coroner 10 1 The appropriate medical examiner must, as soon as practicable, refer the death to the relevant senior coroner where— a after complying with regulations 6 and 8 in relation to the death, the examiner is unable to confirm the cause of death; or b in the course of complying with regulations 6 and 8 in relation to the death, the examiner forms the opinion that the duty to notify the relevant senior coroner arises under regulation 2 of the Notification of Deaths Regulations 2019. 2 If at that time there are exceptional circumstances to justify doing so, a referral under paragraph (1) may be made orally but otherwise must be in writing. 3 The medical examiner who notifies the relevant senior coroner orally under paragraph (2) must, as soon as practicable thereafter, confirm the referral in writing to the relevant senior coroner. 4 When making a referral under paragraph (1), or as soon as practicable thereafter, in addition to complying with the duties set out in regulation 2 of the Notification of Deaths Regulations 2019, the appropriate medical examiner must provide the following information to the relevant senior coroner in relation to the death— a the information provided under regulation 3(1)(c)(ii); b any record made under regulation 7(2); c any record made under regulation 8(1)(c); and d any other information the examiner considers appropriate, except where that information has already been provided to the relevant senior coroner. 5 Where, after receiving a referral under paragraph (1), the relevant senior coroner decides that there is a duty to conduct an investigation into the death under section 1 of the Act— a the relevant senior coroner must notify the appropriate medical examiner of that decision; and b the appropriate medical examiner must notify the relevant attending practitioner of that notification. 6 Where the relevant senior coroner has received a referral under paragraph (1) and decided that there is no duty to conduct an investigation into the death under section 1 of the Act, the relevant senior coroner must— a notify an appropriate medical examiner of that decision and the reasons for it; and b provide the examiner with a copy of any information relied upon in making that decision, except where that information was provided under paragraph (4). 7 After receiving a notification under paragraph (6), the appropriate medical examiner must— a notify the attending practitioner of the relevant senior coroner’s decision and reasons for it; and b make available to the attending practitioner any information provided under paragraph (6)(b). 8 Where an appropriate medical examiner notifies an attending practitioner under paragraph (7), the attending practitioner and appropriate medical examiner must comply with any duties under these Regulations in relation to the death that had not been complied with prior to the referral to the relevant senior coroner under paragraph (1). Confirmed attending practitioner’s certificate to be given to registrar 11 1 The appropriate medical examiner must, without unreasonable delay after confirming the cause of death under regulation 9(2), notify a registrar that the cause of death has been confirmed by giving the confirmed attending practitioner’s certificate to the registrar. 2 After complying with the duty in paragraph (1), the appropriate medical examiner must, without unreasonable delay, take reasonable steps to ensure that a person mentioned in regulation 8(1)(a) is aware that the confirmed attending practitioner’s certificate has been given to the registrar in accordance with paragraph (1). 3 In these Regulations, “ confirmed attending practitioner’s certificate ” means an attending practitioner’s certificate in respect of which the cause of death has been confirmed by a medical examiner in accordance with regulation 9(2). Invitation to attending practitioner to issue a revised attending practitioner’s certificate 12 1 Where an informant provides the registrar with information which leads the registrar to believe that the cause of death stated on the confirmed attending practitioner’s certificate may need to be revised, the registrar must consult an appropriate medical examiner as to any such revision. 2 After consultation with the registrar in accordance with paragraph (1), the appropriate medical examiner must either— a make available to an attending practitioner the information provided under paragraph (1), invite the attending practitioner to revise the attending practitioner’s certificate and inform the registrar of the invitation to revise; or b inform the registrar of the examiner’s reasons not to invite the attending practitioner to revise the attending practitioner’s certificate. Revised attending practitioner’s certificate 13 1 Where the attending practitioner has been invited to revise the attending practitioner’s certificate under regulation 12, the attending practitioner must, as soon as practicable, review— a the deceased person’s relevant health records; b the results of any physical examination of the body of the deceased person undertaken by the practitioner or any other registered medical practitioner; c any information provided under regulation 12(2)(a); and d any other information which the practitioner considers relevant, with a view to establishing the cause of death to the best of the practitioner’s knowledge and belief. 2 Where the attending practitioner agrees to revise the attending practitioner’s certificate, the attending practitioner must, as soon as practicable— a revise the attending practitioner’s certificate; and b make available to an appropriate medical examiner— i the revised attending practitioner’s certificate; ii any information considered under paragraph (1) that has not already been provided to the examiner; and iii any other information relevant to establishing the cause of death, except where that information was provided under regulation 3(1)(c). 3 Paragraphs (4) to (6) apply where, after fulfilling the duties in paragraph (1), the attending practitioner does not agree to revise the attending practitioner’s certificate in relation to a death. 4 The attending practitioner must, as soon as practicable, make available to an appropriate medical examiner— a the attending practitioner’s certificate; b any information considered under sub-paragraph (1)(b); c any other information relevant to establishing the cause of death, except where that information was provided under regulation 3(1)(c); and d the attending practitioner’s reasons for not agreeing to revise the attending practitioner’s certificate. 5 The appropriate medical examiner must, as soon as practicable— a review the information provided under paragraph (4); b to the extent the examiner considers appropriate, comply with the duties set out in regulations 6 to 8 afresh; and c comply with the duties set out in regulations 9 to 11 afresh. 6 When complying with regulation 11 afresh pursuant to sub-paragraph (5)(c), the appropriate medical examiner must inform the registrar of— a the attending practitioner’s decision not to revise the attending practitioner’s certificate and the reasons for that decision; and b any other information the examiner considers relevant. Attending practitioner’s availability to fulfil duties 14 Where an attending practitioner is unable to carry out any duties imposed on the practitioner under this Part within a reasonable time, another attending practitioner must carry out those duties. Part 3 Medical examiner’s certificate Relevant senior coroner referral to a medical examiner 15 1 Where the relevant senior coroner is notified of a person’s death under regulation 2 of the Notification of Deaths Regulations 2019 because the circumstances described in regulation 3(1)(e) or (f) of those Regulations apply, the relevant senior coroner must refer that death to an appropriate medical examiner. 2 Paragraph (1) does not apply where— a the relevant senior coroner has decided that there is a duty to conduct an investigation into the death under section 1 of the Act; or b at the time of the death, the deceased had a relevant association with a visiting force. 3 In making a referral under paragraph (1), the relevant senior coroner must make available to the appropriate medical examiner the reasons for the referral and a copy of such information relied upon in making it. 4 In paragraph (2), references to a visiting force, and to a person’s having, at the time of death, a relevant association with a visiting force, have the same meaning given to those expressions in section 12 of the Visiting Forces Act 1952 . Duties of medical examiner after receiving referral from relevant senior coroner 16 Regulations 17 to 23 apply where a death is referred by the relevant senior coroner to an appropriate medical examiner under regulation 15(1). Referral by relevant senior coroner: medical examiner’s duties 17 1 The appropriate medical examiner must, as soon as practicable and with a view to establishing the cause of death to the best of the examiner’s knowledge and belief— a review the deceased person’s relevant health records; b make whatever enquiries the examiner considers necessary; and c take into account any information— i provided under regulation 15(3); and ii which the examiner considers relevant. 2 The appropriate medical examiner must make a record of any conclusions drawn from taking into account the information referred to in paragraph (1). 3 The appropriate medical examiner may undertake an external examination of the body of the deceased person, or, subject to paragraphs (4) to (7), instruct another individual to do so on their behalf, with a view to establishing the cause of death to the best of their knowledge and belief. 4 The appropriate medical examiner may only appoint another individual to undertake an external examination of the body of the deceased person for the purpose of paragraph (3) where— a in the opinion of the examiner, the individual has suitable expertise; and b none of the circumstances in paragraph (5) apply. 5 The circumstances are that the individual— a is the spouse, ex-spouse, civil partner or ex-civil partner of— i the deceased person (“ D ”); or ii an other relevant medical practitioner (“ OP ”); b is, or was, living together with D or OP as if they were a spouse or civil partner; c is, or was, closely related to D or OP; d attended D during the course of D’s last illness; e is or, was, a partner, employer, employee or associate of D or OP; f had a financial interest in D’s estate; or g has or had any other association, relationship or connection with D or OP such as to give the appropriate medical examiner reasonable doubt as to the individual’s objectivity to carry out an external examination of D. 6 In paragraph (5), “ closely related ” means a parent, sister, half-sister, brother, half-brother, son, daughter, uncle, aunt, grandparent, grandchild, first cousin, nephew, niece, parent-in-law, grandchild-in-law, sister-in-law, brother-in-law, son-in-law, daughter-in-law, stepchild, step-parent, stepbrother or stepsister. 7 In paragraph (6), references to step relationships and in-laws are to be read in accordance with section 246 (interpretation of statutory references to stepchildren etc) of the Civil Partnership Act 2004. Medical examiner’s duty to discuss the cause of death 18 The appropriate medical examiner, or someone acting on behalf of the examiner, must, as soon as practicable— a take reasonable steps to discuss the cause of death with a person who is qualified to give information concerning the death under sections 16(2) or 17(2) of the 1953 Act or any other person whom the examiner considers appropriate; b offer a person mentioned in sub-paragraph (a) an opportunity to raise any matter which might cause the relevant senior coroner to think that there is a duty to investigate the death under section 1 of the Act; and c make a summary record of any discussion under sub-paragraphs (a) or (b) and its outcome. Preparation of medical examiner’s certificate 19 1 Subject to regulation 20(1), the appropriate medical examiner must, as soon as practicable after complying with regulations 17 and 18 in relation to a death, prepare and sign a medical examiner’s certificate. 2 For the purposes of these Regulations, “ medical examiner’s certificate ” means the certificate referred to in section 20(1)(h)(i) of the Act which shall take the form of— a in the case of a death of a child within the period of 28 days beginning with the day of the child’s birth, the certificate in either of the forms set out in Part 1 or Part 2 of Schedule 3; b in the case of any other death, the certificate in either of the forms set out in Part 1 or Part 2 of Schedule 4. Medical examiner’s referral back to the relevant senior coroner 20 1 The appropriate medical examiner must, as soon as practicable, refer the death back to the relevant senior coroner where the examiner— a after complying with regulations 17 and 18 in relation to the death, is unable to establish the cause of death to the best of the examiner’s knowledge and belief; or b forms the opinion that the duty to notify the relevant senior coroner arises under regulation 2 of the Notification of Deaths Regulations 2019. 2 If at that time there are exceptional circumstances to justify doing so, a referral under paragraph (1) may be made orally but otherwise must be in writing. 3 An appropriate medical examiner who refers a death back to the relevant senior coroner orally under paragraph (2) must, as soon as practicable thereafter, confirm the referral in writing to the relevant senior coroner. 4 When making a referral under paragraph (1), or as soon as practicable thereafter, in addition to complying with the duties set out in regulation 2 of the Notification of Deaths Regulations 2019, the appropriate medical examiner must provide the following information to the relevant senior coroner— a the deceased person’s relevant health records and any other information that was considered under regulation 17(1); b the record made under regulation 17(2); c any record made under regulation 18(c); and d any other information the medical examiner considers appropriate, except where that information has already been provided to the relevant senior coroner. 5 Where, after receiving a referral under paragraph (1), the relevant senior coroner decides that there is a duty to conduct an investigation into the death under section 1 of the Act, the relevant senior coroner must notify the appropriate medical examiner of that decision. 6 Where the relevant senior coroner has received a referral under paragraph (1) and decided that there is no duty to conduct an investigation into the death under section 1 of the Act, the relevant senior coroner must— a notify the appropriate medical examiner of that decision and the reasons for it; and b provide the examiner with a copy of any information relied upon in making that decision, except where that information was provided under paragraph (4). 7 After receiving a notification under paragraph (6), the appropriate medical examiner must comply with any duties of the examiner under regulations 17 to 19 and this regulation in relation to the death that had not been complied with prior to the referral to the relevant senior coroner under paragraph (1). Medical examiner’s certificate to be given to a registrar 21 1 The appropriate medical examiner must, without unreasonable delay after preparing and signing a medical examiner’s certificate under regulation 19, notify a registrar that a certificate has been prepared by giving the medical examiner’s certificate to the registrar. 2 After complying with the duty in paragraph (1), the appropriate medical examiner must, without unreasonable delay, take reasonable steps to ensure that a person mentioned in regulation 18(a) is aware that the medical examiner’s certificate has been given to the registrar in accordance with paragraph (1). Registrar’s invitation to medical examiner to issue a revised medical examiner’s certificate 22 Where an informant provides the registrar with information which leads the registrar to believe that the cause of death stated on the medical examiner’s certificate may need to be revised, the registrar must provide that information to the appropriate medical examiner and invite the examiner to revise the medical examiner’s certificate. Revised medical examiner’s certificate 23 1 Where an appropriate medical examiner has been invited to revise the medical examiner’s certificate under regulation 22, the examiner must, as soon as practicable and to the extent they consider appropriate, review— a the deceased person’s relevant health records; b any information provided under regulation 22; and c any other information which the examiner considers relevant, with a view to establishing the cause of death to the best of the examiner’s knowledge and belief. 2 Where the appropriate medical examiner agrees to revise the medical examiner’s certificate, the examiner must, as soon as practicable— a comply with the duties set out in regulation 18 afresh, to the extent that the examiner considers appropriate; b comply with the duties set out in regulations 19, 20 and 21 afresh; and c without unreasonable delay, take reasonable steps to ensure that the informant is aware that the revised medical examiner’s certificate has been given to the registrar under regulation 21(1). 3 Where the appropriate medical examiner does not agree to revise the medical examiner’s certificate, the examiner must either— a inform the registrar of their decision not to revise the certificate and the reasons for it; or b make a referral to the relevant senior coroner under regulation 20. Part 4 Miscellaneous provisions Manner of providing documents 24 1 In these Regulations any requirement to— a give an attending practitioner’s certificate or a medical examiner’s certificate or other document to a person may be satisfied by causing that certificate or document to be given by an electronic communication; and b sign an attending practitioner’s certificate or medical examiner’s certificate may be satisfied by providing an electronic signature but only where the certificate to be signed is also in electronic form. 2 In this regulation— a “ electronic communication ” has the meaning given in section 15(1) of the Electronic Communications Act 2000 ; b “ electronic signature ” has the meaning given in section 7(2) of that Act . Availability of certificates and forms 25 The Secretary of State must— a make the certificates set out in Schedules 1 and 2 available to registered medical practitioners; b make the certificates and forms set out in Schedules 3 and 4 available to medical examiners. Supply of information 25A 1 A supply of information under these Regulations— a does not breach any obligation of confidence owed by the person supplying the information; and b does not operate to require or authorise the disclosure or use of information which would contravene data protection legislation. 2 In this regulation, “ data protection legislation ” has the same meaning as in section 3(9) of the Data Protection Act 2018. Part 5 Transitional provision Transitional provision 26 1 Except where paragraph (2) applies, these Regulations do not apply in relation to a death which occurs before the coming into force of these Regulations. 2 This paragraph applies where, before the coming into force of these Regulations— a the death has not been registered under Part 2 of the 1953 Act; b prior to the coming into force of these Regulations, a registered medical practitioner had not signed a certificate in the prescribed form in accordance with section 22(1) of the 1953 Act (Certificates of cause of death) in relation to the death; and c a senior coroner is not under a duty to hold an inquest into the death under section 6 of the Act. Signed by authority of the Secretary of State for Health and Social Care Maria Caulfield Parliamentary Under Secretary of State Department of Health and Social Care at 6.25 p.m. on 11th April 2024