Revised Medical Certificate of Cause of Death (MCCD) Forms (Form 11) and Electronic Completion
Q1. Why is the Medical Certificate of Cause of Death form changing?
The implementation of The Certification of Death (Scotland) Act 2011 in April 2015 is intended to improve the quality and accuracy of death certification in Scotland.
The first phase of this improvement is the introduction of a new MCCD form (Form 11) on August 6, 2014 for all deaths certified at midnight or after on August 6, 2014.
Q2. What are the main changes to the Medical Certificate of Cause of Death form?
The new Medical Certificate of Cause of Death form will be a double sided form in five sections (A to E). The main changes are the inclusion of:
- The deceased's CHI number
- The Health Board area in which the death occurred
- The certifying doctor's GMC number and business contact telephone number
- Information about potential disposal hazards.
The counterfoil (used for recording details of each certified death) has also been removed. This has been replaced by a separate, stapled-in four page Record of Issue sheet, which is formatted to match the cause of death section of the Form 11 in order to better facilitate certifying doctors’ recording of cause of death details for future reference.
Q3. What should a doctor do if he/she accidentally completes an old MCCD from August 6, 2014?
As the Form 11 is a legal form, if an 'old' form is used after midnight of August 5, 2014, this will not be a legitimate document and will need to be be returned to the certifying doctor to redo using the 'new' form. If in extraordinary circumstances the certifying doctor is not available, then during this period of transition from the 'old' forms to the 'new' forms, another doctor who has knowledge of or has access to the clinical records of the deceased can complete a 'new' form for the informant to take back to the registration office.
Q4. What should a registrar do if someone turns up with the old Medical Certificate of Cause of Death form after August 6, 2014?
If the 'old' form was certified by the doctor prior to midnight on August 5, 2014 then this is the appropriate form and should be processed by the registrar following existing procedures (The National Records of Scotland's IT systems will be able to cope with inputs from both old and new forms).
The old Medical Certificate of Cause of Death form ceases to be a legal document at midnight on August 5, 2014, and if the death certification is completed after that time should be rejected by the registrar, irrespective of the time and date of death.
Q5. From August 6, 2014 can a new MCCD be requested as a replacement for an existing one?
Replacement Medical Certificate of Cause of Death forms can be provided by the same certifying doctor, and only in exceptional circumstances by a different doctor - for example, the certifying doctor has died, is incapacitated, or has permanently left the country. Replacement Medical Certificate of Cause of Death forms cannot be issued by a different doctor if there is a difference of clinical opinion.
If a replacement is issued, the first Medical Certificate of Cause of Death form has to be retained in the patient's clinical records but crossed out and annotated that a replacement has been issued (with a different number), with the reason for the replacement and the reason for a different doctor annotated in the clinical records.
Q6. Can doctors complete the Medical Certificate of Cause of Death form electronically from August 6, 2014?
IT systems are being developed to enable doctors to complete the new Medical Certificate of Cause of Death form electronically. This initiative will initially be rolled out to GP practices in April 2015 and subsequently in other settings such as hospitals and hospices.
However, even where electronic completion of the Medical Certificate of Cause of Death form is in place, a paper copy of the Medical Certificate of Cause of Death form will still need to be printed, signed and given to the informant as the means of attestation remains a signature on paper for the time being. This may change in the future, and work is underway to consider electronic attestation.
Q7. Why does the new Medical Certificate of Cause of Death form have some of the same questions that are also on the cremation forms? Do doctors have to complete both?
The new Medical Certificate of Cause of Death form has been revised to assist in the implementation of certain provisions of the Certification of Death (Scotland) Act. The Medical Certificate of Cause of Death form now requires the certifying doctor to confirm whether the body contains any potentially hazardous devices such as pacemakers or other implants to be removed and disposed of safely before cremation, and whether there are any public health risks associated with the body of the deceased:
Cremation forms B and C will continue to be required until the implementation of the Certification of Death (Scotland) Act in April 2015. This means that for the period between August 2014 and April 2015 some information will need to be duplicated on both the new Medical Certificate of Cause of Death form and forms B and C.
The new Form 11 has been introduced earlier than the new system of medical scrutiny in order to give certifying doctors, registrars and other staff time to get used to the new form before the scrutiny system comes into force in April 2015. Following April 2015 cremation Forms B and C will no longer be needed.
Q8. What happens if the deceased is being taken out of Scotland? Do clinicians still complete the Medical Certificate of Cause of Death form?
Yes, where a death occurs in Scotland, a Medical Certificate of Cause of Death form should be provided and the death registered in Scotland. Cremation forms B and C will continue to be required in all cases including those where the funeral is taking place outside of Scotland until the implementation of the Certification of Death (Scotland) Act in April 2015.
Q9. Some GP practices in Scotland have patients who reside in England and some GP Practices in England have patients who reside in Scotland - which MCCD forms should be used for which patients?
Place of death determines which form is used and which country the death is registered. Therefore any death which occurs in Scotland should be registered in Scotland. The certifying doctor will need to work within the revised processes of the country in which the death takes place. Affected Health Boards should ensure distribution of Medical Certificate of Cause of Death forms which covers all eventualities for their area.
Q10. What happens if a clinician thinks the death is suspicious? Should they still complete Medical Certificate of Cause of Death form?
Procurator Fiscal (PF) reporting criteria (and processes) remain unchanged. All reportable deaths must be notified to the Procurator Fiscal as soon as possible after death is verified. In these cases an Medical Certificate of Cause of Death form should not be completed.
You should ensure you are familiar with the Death and the Procurator Fiscal guidance (October 2008) [PDF, 261.15 kb] (which is in the process of being updated).
If a clinician is in doubt about where a death should be reported he or she should seek advice from the Procurator Fiscal in whose jurisdiction the death occurred. If after discussion it is established that the death is not reportable a Medical Certificate of Cause of Death form should be completed. Please do not tick the PF box in Section E.
Q11. Will local registration offices continue to have Medical Certificate of Cause of Death form books?
No. With the new Medical Certificate of Cause of Death form coming into force on August 6, 2014, National Records of Scotland will no longer supply local registration offices with additional books of forms. Instead, additional copies can be ordered direct from your Health Board contact. Details of who to contact can be obtained using the link below:
Appropriate inventory control procedures should be put in place to ensure sufficient stock at all times.
Additional books will be dispatched as soon as the request is received by the National Records of Scotland and the anticipation is that the books will be received by secure means within two working days.
Q12. Should Health Boards keep a record of who and where their supply of books are sent to and numbers on the books?
Yes. This is good practice and will help any audits undertaken in the future. National Records of Scotland will keep a record of the book numbers that are sent to each Health Board.
Q13. Can Medical Directors have 'standby books'?
Yes. If Medical Directors wish to retain a book of Medical Certificate of Cause of Death forms as back up then they should take a book from the supply sent to the Health Board or request additional copies from the health board contact using the contact details below:
Q14. Where can clinicians access more guidance on completing the new MCCD?