What the medical examiner does — and what changed in September 2024

Since 9 September 2024, every death in England and Wales that is not referred to a coroner must be reviewed by an independent medical examiner before the Medical Certificate of Cause of Death (MCCD) is released and the death can be registered. The process is free, takes around 1–2 working days, and requires nothing from you — though the ME's office may contact next of kin.

What changed in September 2024

Medical examiners were first piloted in some NHS trusts in England from 2019 to improve the scrutiny of deaths that were not referred to a coroner. Before September 2024, the system was not universal — many deaths were not reviewed by a medical examiner at all.

The Health and Care Act 2022 made the system mandatory across England and Wales. From 9 September 2024, every non-coroner death must go through medical examiner scrutiny before the MCCD can be released to the family or register office. This is a significant change that is more current than many existing resources — including some GOV.UK and Age UK pages — reflect.

What the medical examiner does — step by step

1. The attending doctor writes the MCCD. The doctor who attended the deceased during their final illness writes the Medical Certificate of Cause of Death, stating the cause and sequence of events that led to the death.
2. The MCCD is submitted to the ME's office for scrutiny. This happens automatically — the family does not need to do anything at this stage.
3. The medical examiner reviews the MCCD. The ME is an independent senior doctor who is not involved in the care of the deceased. They check that the cause of death is accurate, consistent with the patient's medical history, and that the MCCD has been completed correctly. They also consider whether the death should be referred to the coroner.
4. The ME may contact next of kin. As part of their review, the ME's office often makes what is called the "next-of-kin conversation" or "ME conversation." This is a short, informal call to ask whether the family have any concerns about the care the deceased received or the cause of death. It is not alarming — it is routine.
5. The ME signs off the MCCD. Once satisfied, the ME certifies the MCCD. It is then released to the family so the death can be registered.
6. The family can register the death. Once you have the MCCD, you can book an appointment at the register office. The 5-day registration clock runs from when the register office receives the MCCD.

The next-of-kin conversation — what to expect

The ME's office may call next of kin as part of the scrutiny process. This call is typically brief and informal. They may ask:

• Whether the family have any concerns about the care the person received
• Whether the stated cause of death makes sense given what you know about their health
• Whether there is anything about the circumstances that feels unclear

You do not need to prepare for this call — just answer honestly. If you have concerns, this is the moment to raise them. The ME is independent of the hospital or GP surgery that treated the deceased, so you can speak freely.

Not every family will receive a call — in some cases the ME's review is completed without it. If you have concerns and have not been contacted, you can reach out to the ME's office directly through the hospital or NHS trust where the death was registered.

How long does it take?

In most cases, the medical examiner process is completed within 1–2 working days of the attending doctor submitting the MCCD. Weekends and bank holidays are not working days and are not counted in this estimate.

If the ME review takes longer — for example if the ME has questions for the attending doctor, or if the death is more complex — the hospital bereavement office will usually be able to give you an updated timeline.

The 5-day registration clock does not start until the register office receives the MCCD. So any time spent in the ME review does not count against your five days.

What if I have concerns about the cause of death?

The ME process exists partly so that families have a formal route to raise concerns. If you are worried that:

• the stated cause of death does not match what you understood about their health
• there may have been a clinical error or neglect that contributed to the death
• the care they received was inadequate

— you can raise these concerns with the ME's office. Contact the bereavement office at the hospital or NHS trust involved and ask to speak to the medical examiner's team. They are independent and their role specifically includes listening to family concerns.

If the ME shares your concerns after reviewing the case, they may refer the death to the coroner for further investigation. The coroner can hold an inquest if appropriate. This will pause the registration process, but the coroner's office will keep you informed.

Medical examiner vs coroner — the difference

Frequently asked questions

Once the MCCD is released, your next step is to register the death. See our guide to how to register a death in England and Wales, and the full what to do when someone dies guide for the complete timeline.