This article relates to the CQC key questions: Is your practice safe? and Is your practice effective?
The CQC has had a number of queries about who can confirm death in a care home, in cases where the death was expected.
The general agreement has been that, in cases like this, any competent adult can confirm death. We expect a competent adult to be an individual with the knowledge, skills and competencies required to be able to confirm death. Therefore a doctor does not need to confirm an expected death in a care home. However, there is some variation in implementation.
While we do not have a specific CQC policy on this, we can look to national guidance and English Law. The BMA guidance is clear and summarises the issue very well.
The guidance clarifies the distinction between confirming and certifying death in relation to GPs' obligations.
To comply with statutory requirements
- does not require a doctor to confirm death has occurred or that 'life is extinct'.
- does not require a doctor to view the body of a deceased person.
- does not require a doctor to report the fact that death has occurred.
- does require the doctor who attended the deceased during the last illness to issue a certificate detailing the cause of death.
The BMA advises the following for expected and unexpected deaths:
For an expected death
'If the death occurs in the patient's own home, it is wise to visit as soon as the urgent needs of living patients permit.
'If the death occurs in a residential or nursing home and the GP who attended the patient during the last illness is available, it is sensible for him or her to attend when practicable and issue a death certificate.
'If an "on-call" doctor is on duty, whether in or out of hours, it is unlikely that any useful purpose will be served by that doctor attending the nursing or residential home. In such cases we recommend that the GP advises the home to contact the undertaker if they wish the body to be removed and ensures that the GP with whom the patient was registered is notified as soon as practicable."
For an unexpected ('sudden') death
'If death occurs in the patient's home, or in a residential or nursing home, we recommend a visit by the GP with whom the patient was registered, to examine the body and confirm death, although this is not a statutory requirement.
'Unlike expected deaths, in the event of an unexpected death out-of-hours it would be helpful if an OOH GP does attend, therefore helping to prevent the potentially unnecessary attendance of the emergency services.
'The GP should then report the death to the coroner (usually through the local police).
'In any other circumstances, the request to attend is likely to have come from the police or ambulance service. It is usually wise, and especially in the case of an on-call doctor, to decline to attend and advise that the services of a Forensic Medical Examiner police surgeon be obtained by the caller."
- Professor Nigel Sparrow is senior national GP advisor and responsible officer at the CQC
More CQC resources
- View the full CQC Essentials series on Medeconomics
- CQC's recommended reading to help practices meet regulations and prepare for an inspection