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Written by Adam McIlroy.
15 minute read
On 9 September 2024, the biggest changes to death registration in England and Wales for over 50 years came into force. The reforms affect every family going through a bereavement, changing who reviews the cause of death, how paperwork is handled, and what families can expect from the process.
This guide explains what changed, why, and what it means for you. If you have recently been bereaved, you may also be looking for guidance on what to do when someone dies, including the practical steps that need to happen first.
On 9 September 2024, the most significant reforms to the death certification system in England and Wales for more than 50 years came into effect.
The previous system had remained largely unchanged since the 1950s. Over time, concerns were raised about whether there was enough independent scrutiny of deaths before certificates were issued. Many of the reforms trace back to recommendations made following the Harold Shipman inquiry. Shipman, a GP, was able to kill hundreds of patients partly because there was no independent process for reviewing the deaths he certified. The new system introduces mandatory independent review for every non-coronial death.
The reforms were introduced under the Health and Care Act 2022 and came into force through the Medical Certificate of Cause of Death Regulations 2024.
Although the process now involves an additional review stage, the aim is to make death certification safer, clearer and more consistent for families. In many cases, the new system also reduces unnecessary referrals to the coroner and simplifies cremation paperwork.
A Medical Examiner is a senior NHS doctor who has received specialist training in the legal and clinical aspects of death certification. Importantly, they are independent of the doctor who treated the person who has died.
Their role is to carefully review the proposed cause of death and make sure it is accurate. They also check whether the death should be referred to the coroner.Medical Examiners work alongside Medical Examiner Officers (often called MEOs), who support the process and communicate with families.
One of the biggest changes for bereaved families is that the Medical Examiner’s office now contacts the family representative directly. This gives families the opportunity to ask questions about the cause of death or raise any concerns about the care the person received before they died.
Medical Examiner services are usually based within NHS trusts and oversee deaths in hospitals, care homes, hospices and private homes across their local area. The purpose of the system is reassurance and transparency. It is designed to make sure every death is reviewed independently and that families have a clear point of contact during the registration process.
If you receive a phone call or letter from a Medical Examiner’s office after someone you love has died, this is completely normal. It does not mean that anything suspicious has happened or that there is an investigation.
In most cases, a Medical Examiner Officer will contact the next of kin or the family’s nominated representative. They will usually:
The conversation is typically short, calm and supportive. You do not need to prepare documents or provide medical information.
You may also use this opportunity to ask questions if there is anything you do not understand about the cause of death or the process ahead. Once this contact has taken place, the Medical Examiner sends the MCCD directly to the registrar so the death can be formally registered.
Under the new system, the death registration process is designed to be more joined-up and less administrative for families.
Many families also ask if you need a death certificate for a funeral. In most cases, the funeral can go ahead once the registrar issues the Green Form, even if official death certificates have not yet been purchased.
This can be reassuring for families who are arranging a funeral before registering a death, particularly where there are delays in the paperwork process.
Under the previous system, families were sometimes responsible for collecting paperwork or waiting for forms to be transferred between services. The new process removes much of that responsibility.
Once the Medical Examiner confirms that the MCCD has been sent to the registrar, you can usually contact the register office directly to arrange an appointment.
You may be asked to bring supporting documents to the appointment, such as:
However, registration can normally still go ahead even if some documents cannot be found. If you are unsure how to get a death certificate, the registrar can explain how many certified copies you may need and how to purchase them during your appointment.
One of the most important practical changes is when the legal registration deadline begins.
Under the new system in England and Wales, the 5-day registration period starts from when the registrar receives the MCCD from the Medical Examiner’s office – not from the date of death. This change removes some of the pressure families previously felt while waiting for doctors to complete paperwork.
Under the old system, families could feel anxious that the legal deadline was approaching even though they were still waiting for medical forms to be completed. Now, administrative delays before the MCCD reaches the registrar are not considered the family’s responsibility.
Once you are told the registrar has received the certificate, it is important to arrange the appointment promptly. If you are unsure whether the registration period has started, you can contact the registrar’s office directly. They can confirm when they received the certificate.
In Scotland, the registration deadline remains 8 days from the date of death.
Under the previous system, the attending doctor needed to have seen the person within 28 days before they died, or seen the body after death, to complete the MCCD.
If no doctor met this requirement, the death had to be referred to the coroner. This could sometimes lead to distressing delays for families, even where the death was expected.
There was also no routine independent review for expected deaths before the MCCD was sent to the registrar. For cremations, two separate doctors needed to complete additional forms confirming the cause of death. Families were charged fees for this process.
The 28-day rule has now been removed. Any doctor involved in the person’s care during their lifetime may complete the MCCD where appropriate. Every non-coronial death is now independently reviewed by a Medical Examiner before registration.
Because more doctors are able to certify deaths, fewer cases need to be referred to the coroner unnecessarily. This can reduce delays and help families move forward with funeral arrangements more smoothly.
For cremations, the previous two-doctor certification process has been abolished. The Medical Examiner’s review now replaces the old additional doctor forms, and no separate doctor’s fee applies.
Some deaths must still be referred to the coroner. This includes:
In these situations, the coroner may investigate further before allowing registration or the funeral to proceed.
The coroner can issue an Interim Death Certificate in some cases, which may help families begin administrative tasks such as probate while investigations continue. Although coroner investigations can still cause delays, the new Medical Examiner system means fewer straightforward deaths are referred unnecessarily.
The cremation process, particularly the related paperwork, has changed significantly under the new regulations.
Before September 2024, cremations required two separate cremation forms completed by two different doctors. One doctor completed the first certificate, while another independent doctor completed a second form confirming the cause of death.
Families were charged fees for these forms, typically totalling £164. For deaths occurring after 9 September 2024, these forms are no longer required.
Instead, the Medical Examiner’s independent review of the MCCD replaces the previous two-doctor cremation certification process.
This means:
Families or funeral directors still complete the cremation application form confirming the family’s wishes. The registrar’s Green Form is also still required before the cremation can proceed.
If the death is referred to the coroner, the process is slightly different, and the coroner provides the necessary authority for cremation.
It can also help to understand the difference between a cremation certificate and death certificate. A death certificate is the official legal record of the death, while a cremation certificate confirms that the cremation has taken place.
In the months immediately after the September 2024 reforms were introduced, some families experienced delays while hospitals, GP surgeries, Medical Examiner offices, and registrars adapted to the new process.
There were also some early technical issues affecting communication between services. The system has now largely stabilised, and for most straightforward deaths the Medical Examiner review adds only one or two working days.
If you are experiencing delays, it can help to contact:
Useful questions to ask include:
It is important to remember that families are not penalised for delays caused by the medical system. The 5-day registration deadline only begins once the registrar receives the certificate.
No. The September 2024 reforms apply to England and Wales only.
Scotland has its own death registration system. Unexpected or unexplained deaths are investigated by the Procurator Fiscal, which performs a similar role to the coroner in England and Wales. Scotland’s registration deadline remains 8 days from the date of death.
Northern Ireland also has a separate process with its own registration procedures and legal requirements.
If the person who has died lived in Scotland or Northern Ireland, it is best to follow local guidance or speak with a funeral director familiar with the regional process.
Navigating a new administrative process during a bereavement can feel overwhelming, even when the changes are designed to make things simpler for families.
Our Aura Angels are experienced in the new death registration process and can support you with everything from understanding Medical Examiner contact to arranging the funeral itself. If you need help with paperwork, registration, or knowing what happens next, we are here to guide you through it.
If you are arranging a funeral or would like a loved one brought into our care, our phone lines are open 24 hours a day, seven days a week. Call us free on 0800 808 5723.
If you are planning ahead for the future with a prepaid funeral plan, our dedicated planning team is available Monday to Friday, 9am-5pm.
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From 9 September 2024, every non-coronial death in England and Wales must now be independently reviewed by a Medical Examiner before registration.
The Medical Examiner sends the Medical Certificate of Cause of Death directly to the registrar, simplifying the process for families. The reforms also removed the old two-doctor cremation certification system and changed when the 5-day registration deadline begins.
A Medical Examiner is a senior NHS doctor trained in death certification. They independently review the proposed cause of death, make sure the certificate is accurate, and decide whether the death should be referred to the coroner.
They also give families the opportunity to ask questions or raise concerns about the care the person received before they died.
The attending doctor completes the Medical Certificate of Cause of Death, which is reviewed by the Medical Examiner. Once the review is complete, the Medical Examiner sends the certificate directly to the registrar. The family can then arrange an appointment to formally register the death and receive the documents needed for the funeral.
The previous system required two separate doctors to complete additional cremation forms, which created extra costs for families.
Those forms have now been abolished for deaths occurring after 9 September 2024. The Medical Examiner’s review replaces the old process, which means less paperwork and no separate doctor’s cremation certification fee.
In many straightforward cases, yes. The new process reduces unnecessary referrals to the coroner and simplifies the transfer of paperwork between doctors and registrars. Although the Medical Examiner review can add a short administrative step, the overall process is now more consistent and transparent.
Under the old system, deaths often had to be referred to the coroner if no doctor had seen the person within 28 days before death. That rule has now been removed. Any doctor involved in the person’s care during their lifetime may complete the MCCD where appropriate, helping reduce unnecessary coroner referrals.
Yes. Coroners are still involved where deaths are sudden, unexplained, suspicious, related to accidents, or require further investigation. The Medical Examiner system does not replace the coroner. Instead, it helps ensure that only deaths genuinely requiring investigation are referred.
Yes. Families still need to attend a registration appointment at the register office. However, the medical paperwork is now sent directly from the Medical Examiner to the registrar, which means there is less administration for families to manage themselves.
The reforms are intended to make the process more transparent, reduce unnecessary delays, simplify cremation paperwork, and give families a clearer opportunity to ask questions about the cause of death. The aim is to create a more supportive and consistent system during an already difficult time.
This is completely normal and expected. The Medical Examiner or Medical Examiner Officer will usually call to explain the cause of death, ask whether you have any questions, and confirm when the paperwork has been sent to the registrar. It is not an investigation, but part of the new support and review process.
No. The September 2024 reforms apply only in England and Wales. Scotland has its own death registration process and uses the Procurator Fiscal system for deaths requiring investigation.
Absolutely. If you’re arranging a funeral, Aura’s Angel team is here to:
Talk you through the process
Answer questions about registration or documentation
Handle admin on your behalf where possible
You don’t need to face the paperwork alone.