Medical Examiner

The introduction of medical examiners will improve the death certification process by increasing the accuracy of the MCCD for deaths that are not investigated by a coroner. The National Medical Examiner system forms part of the NHS Patient Safety Strategy in England and is an important component of improving patient safety. Medical examiners provide independent scrutiny of causes of death and the care before death, and facilitate feedback from the bereaved. The Government’s proposals for medical examiners, and for a new rigorous, unified system of death certification for both burials and cremations in England and Wales, is part of the response to several independent enquiries. 6 In June 2016, the Government consulted on a package of reforms to the death certification process, including the introduction of medical examiners. The Government’s response to this was published in June 2018 and set out its intention to introduce a system of medical examiners in the NHS. The Welsh Government issued a response to its consultation on areas of the medical examiner service devolved to Wales in June 2018. The medical examiner system will be enshrined in statute, but this will take some time. NHS England and NHS Improvement, DHSC, the Welsh Government and NHS Wales Shared Services Partnership are working together to implement the non-statutory system for non-coronial deaths with the intention that during 2020/21 it will cover all non-coronial deaths, not just those that happen in hospitals.


The objective is for medical examiners to independently scrutinise all non-coronial deaths across England and Wales. We expect most medical examiner offices will be located in acute sites in England with, potentially, certain specialist trusts. In Wales, offices will also be based in acute hospitals but managed by NHS Wales Shared Services Partnership (NWSSP).

National Medical Examiner’s report 2020