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30 March 2020
Dear Colleague
In response to the rapidly developing covid-19 situation I would like to:
- remind you of the need to practice safely, and
- provide a much needed update on death certification following the enactment of measures in last week’s Coronavirus Act.
As ever, this information is as current as possible and may be subject to change. If that should happen, my team and I will update you as soon as possible.
1. Practising Safely
Practising safely protects patients, staff and colleagues and minimises the risk of covid-19 transmission in practices in the absence of widespread covid-19 testing, and with data from Italy and China suggesting that ‘cold’ patients and health care workers are significant vectors for spreading disease.
Practising safely involves:
- operating a remote screening system;
- carrying out consultations remotely through video or phone wherever possible;
- only seeing patients face to face (in the surgery or through home visits) if initial assessment deems it essential;
- screening people prior to entry;
- miniminising the time a person spends in practice;
- minimising the number of people the patient encounters;
- wearing PPE for all face-to-face consultations and making sure all staff adopt correct donning and doffing techniques.
This advice will be updated as more evidence becomes available from agencies such as PHE and NHSEI, such as the letter emailed out from NHSEI Primary Care Director Dr Nikki Kanani which crossed with my own on Friday evening.
2. Changes to Death Certification
Coroners offices have confirmed that there is no need for the doctor to see the patient after death as long as any doctor saw them in the 28 days before death (including for verification of death). The doctor should write 'N/A' on the Cremation Form 4 where it asks about what examination was made of the body. Ideally they should say who did see the patient when alive.
Any doctor can now complete the MCCD as long as a doctor saw them in the 28 days before death. They do not have to have seen the patient alive and they can also complete Cremation Form 4, with some caveats: Section 8 of the form should be completed as NA; the doctor completing the form should indicate (if possible) which doctor saw the patient in the 28 days prior to death, and; if no doctor saw the deceased within the 28 days before death, the body should be seen after death to avoid referral to the Coroner - this is the only circumstance in which the body needs to be seen after death.
Video/telemedicine counts for 'attending' a patient during life but not after death – please refer to the information at the following link: Advice from the General Register Office.
As ever I welcome your feedback at mword@lmc.org.uk, and know that my team of experts and leaders here at Londonwide LMCs will always be by your side.
Keep well. Stay safe.
With best wishes
Dr Michelle Drage MBBS FRCGP
CEO, Londonwide LMCs
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