Care provided after death
GPs have an integral role in providing care for patients who are approaching the end of their life. They provide medical care for patients dying at home or in nursing and residential homes. They provide sensitive and compassionate support for relatives when death occurs and in the immediate period afterwards, liaising with the professional staff and carers who have looked after the patient. They will also be contacted if their patient has died suddenly at home or in a public place.
GPs are also responsible for a number of steps that allows legal registration of the death and a funeral to take place:
- Verifying life extinct: (verification of death, pronouncing death, confirming death) is the first step
- Completing the medical certificate of cause of death: this is a statutory legal duty. A doctor who had seen and treated the patient in the last 28 days for a natural illness that caused their death may issue a Medical Certificate of Cause of Death (MCCD) which the family then presents at a local council office to have the death registered and receive a death certificate.
- Reporting a death to the Coroner: a doctor has a duty to report any death to the Coroner if it resulted, directly or indirectly, from any cause other than natural illness or disease for which the patient had been seen and treated within 28 days of death.
- Cremation Certificate: for a cremation to take place the signature of 2 doctors are required on cremation documentation
- Relatives (to be agreed)
- Medical practice colleagues
- Out of Hours Medical services
- District Nurses, Midwives, Care Home staff and other caring services involved with the patient
- Integrated Care Teams e.g. Social Worker
- Independent providers of healthcare e.g. Macmillan/Marie Curie/Hospice Services
- Ambulance service
- Coroners Service/PSNI
- Funeral Directors
- Administration/secretarial staff
- Clinical governance colleagues supporting processes in relation to clinical audit, case review and reporting death
The standard of bereavement care is enhanced when:
- The GP is informed about the death as soon as possible after death occurs. This is particularly important when a patient dies in hospital.
- The GP shares information about the death with other members of the team involved in the patients care who can provide support, advice and information to the bereaved
- Follow up appointments are offered to relatives to explain further the cause of death, post mortem results etc.
- Medical certificates of cause of death and cremation certificates are completed as soon as possible after death
- The Coroners Service/Medical Advisor is available for guidance when a death is reported
- Practices have training, supervision and support systems in place for doctors
Standards and Guidelines
- General Medical Council. (2009) Good Medical Practice. GMC
- General Medical Council (2010) Treatment and care towards the end of life: good practice in decision making. GMC
- DHSSPS (2008) Verifying and Recording Life extinct by appropriate professionals. Circular HSS (MD) 8/2008. http://www.dhsspsni.gov.uk/hssmd-8-2008.pdf
- DHSSPS (2008) Guidance on Death, Stillbirth and Cremation Certification. http://www.dhsspsni.gov.uk/guidance-death-stillbirth-and-cremation-certification-pt-b.pdf
- Coroner Service NI (2009) Working with the Coroners Service- best practice guide. http://www.courtsni.gov.uk/en-GB/Services/Coroners/publications/Pages/coroners_Publications.aspx
- The Royal College of GPs http://www.rcgp.org.uk/