A GP in England was asked to complete a death certificate for a patient of the practice who died at home following a clinical diagnosis of COVID-19.
The GP had not met the patient for many months and had not had any contact with the patient during the last illness. The notes recorded that the patient had had two telephone consultations in the fortnight before death, both with another GP who had since become unwell and was away from work, and not expected to return for several weeks.
The GP called the MDU and asked whether, in light of the new legislation brought in recently, it would be reasonable for her to complete and sign the death certificate.
The adviser confirmed that the Coronavirus Act 2020 had changed death certification during the emergency period. The medical certificate of cause of death (MCCD) can, at this time, be signed by a doctor who has not attended the patient if it is not practicable for the attending doctor to do so themselves (for example, if that doctor has now become unwell).
The doctor planning to sign the MCCD can do so if they have access to relevant information and are able to give a cause of death, and if the patient was attended during their last illness.
The GP believed the patient to have died of COVID-19, but this patient had not been seen face-to-face or by video in the 28 days before death - and the guidance from NHS England/ NHS Improvement relation to the excess death provisions of the coronavirus Act made clear that a telephone consultation does not count as an attendance. The deceased had also not been seen after death by a medical practitioner.
In such circumstances, the registrar is obliged to refer the death to the coroner before it can be registered, so while it is technically still possible for the GP to complete and sign the MCCD in these circumstances, they would be expected to do so only if the coroner had agreed.
Because of this, the adviser recommended the GP contact the coroner before going ahead. The adviser also explained that the wording of the MCCD would need to reflect that the GP had not attended the patient in their last illness.
This article appeared in the 2020 edition of Cautionary Tales.