Cremation Regulations 2008

New regulations concerning cremation come into force on 1st January 2009. The full guidance for doctors is available here but the main new points are as follows:

Who may sign?

• The doctor signing the form Cremation 4 ("part one") should have treated the deceased during the last illness, and seen the deceased within 14 days of death.
• A partner may be acceptable if the attending partner is away and he or she has seen the patient previously, but the Coroner should normally be advised.

Cause of death

• Modes of death (such as 'multi organ failure' or 'heart attack' are unacceptable.
• 'Old age' is acceptable for registration purposes where the deceased is older than 80 years, but it is unlikely to be acceptable for cremation purposes and medical referees may make further enquiries. The cause of death must be ascertained.

Other points

• There is a new question on form Cremation 4 which asks you to "describe the symptoms and other conditions which led to your conclusions about the cause of death".
• You should give full names and address details of those who nursed the deceased or were present at the death.
• You must give the deceased's last occupation if he or she was retired or not in work at the time of death.
• You must state whether any persons present at the death have any concerns regarding the cause of death.
• You must give details of any discussions with the Coroner's office.
  

Source: Ministry of Justice website

Comments from Nottingham Medical Referees

Relatives now have a right of access to the completed forms. They may ask the Medical Referees for clarification, and so the forms need to be submitted at least 72 hours in advance of the cremation.

Undertakers

• Please try to determine the last occupation of the deceased.
• Please state the relationship of the applicant to the deceased.
• Please try to give information about implants.

Doctors

It would seem sensible to discuss the cremation papers with an appropriate relative before you fill them in. All information needs to be independently verifiable so it is important always to give names and contact telephone numbers.

Form 4 (old "part one")

• There needs to be some indication of the deceased's last occupation.
• The death must be discussed with the coroner if you haven't seen the deceased within 14 days before death.
• Q9. You are expected to give an account of how you formed your conclusions regarding the cause of death. This may include some past medical history, history of events leading up to death, diagnostic test results. If you include history from a third party please give names and contact details.
• Q11. Old Age is no longer acceptable as a cause of death save in exceptional circumstances. If the cause of death cannot be clearly determined the death should be reported to the coroner.
• Q12. You must give details of any operation within the preceding 12 months. You need not report such a death to the coroner if you believe the operation had no bearing on the cause of death, but it would be prudent to report any operation directly relating to the cause of death (e.g. a bowel resection in someone who died of colon cancer) or in the month prior to death.
• Q14-16. You must give names and contact details of people who nursed the deceased or were present at the time of death, and you should talk to them about the circumstances of death.

Form 5 (old "part two")

• You must check Form 4 thoroughly and highlight any errors or omissions. You should not amend Form 4 yourself, but bring them to the attention of the first part doctor (who should come and correct them) and make any comments under "Reasons for disagreeing" under Q7.
• You must speak to the first part doctor and at least one other person who has knowledge of the circumstances of the death.
• Q2-5. Where it is not clear, please give some indication of how this person may have knowledge of the death (e.g. Mrs Smith - nursing home matron, or Mr Jones - son of deceased).
• Q7. If you tick the box to say you agree with the cause of death you no longer have to complete the section below regarding the causes of death. But if you do complete it, please make sure it is the same and in the same order.

The Referees will help you whenever possible but the new regulations are very precise in their requirements and we will all have to work within them.
Source: letter from Dr Nick Page, December 2008

Focus Line

Nottingham Focus Line has been commissioned and funded by the Nottingham PCTs to meet the requirements of the National Service Framework to offer individuals experiencing mental health distress access to services 24/7. It is available to any adult who has a mental health problem, to carers and to professional agencies; and offers confidential support, information and emotional support, including liaison with psychiatric and social work services.
It would be suitable for people who are continually engaging with the practice and require support throughout the evenings, night and weekends.

Churchill House
14 Heathcoat Street
Nottingham  NG1 3AA
Tel. 0115 911 6254
Fax. 0115 844 7620

Focus Line - 0800 027 2127

Source: letter from Focusline

Emergency gynaecology & early pregnancy assessment

On the 1st December 2008 the City Campus based Early Pregnancy Assessment Service and all emergency gynaecology previously admitted to City Campus will move and amalgamate with the Emergency Gynaecology/EPAU Service at the QMC Campus.

The new service will be based on Ward C30 at the QMC Campus and will be open from 8.00 am to 8.00 pm. Emergencies outside of these hours should be directed to the Emergency Department at the QMC.

The service can be contacted using the numbers below:

Tel 0115 9249924: ext. 64874, 62287 or 67385
Fax 0115 8754545

Source: letter from Martin Powell, 24th November 2008

Hepatitis C - improving detection

The CMO has written asking us to improve the detection and diagnosis of Hepatitis C in primary care. There may be about 100,000 with undiagnosed chronic hepatitis Cd. Effective drug therapy can prevent progression to cirrhosis and primary liver cancer, but the disease is usually asymptomatic. Unless a patient has unexplained abnormal LFTs the only indication for offering testing will be risk factors.

Blood-borne virus

Hepatitis C is mainly spread through direct blood-to-blood contact. In this country, patients who may have injected drugs (even if only once, a long time ago) are most at risk. Other transmission routes include blood transfusion (before September 1991) or any blood product (before 1986) in the UK, tattooing or piercing with unsterile equipment, or sharing razors or toothbrushes with an infected person. There is a small risk of contamination from mother to child during pregnancy and through unprotected sex. Medical or dental treatment in countries where hepatitis C is common (parts of Middle East, Asia and Africa) and where infection control may be poor is also a risk. Pakistani communities in this country may be at increased risk of infection.

Who to screen

Hepatitis C testing should be offered to anyone who:

• has unexplained abnormal LFTs (raised ALT or bilirubin)
• has used shared equipment to inject drugs, however long ago
• has had a blood transfusion in the UK before September 1991 or received any blood product before 1986
• has received medical or dental treatment in countries where infection control may be poor
• is the child of a mother with HCV
• is a regular sexual partner of someone with HCV
• has been accidentally exposed to blood where there is a risk of transmission of HCV
• has had tattoos, piercings, acupuncture or electrolysis where infection control procedures are poor

Dealing with results

Positive antibody results should be confirmed by a second sample, when tests for HCV RNA can be carried out if the positive result is confirmed. About 20% to 40% of people will clear the virus naturally. If HCV RNA is positive they have not cleared the virus and should be referred to a specialist. If HCV RNA is negative they have cleared the virus, referral is not required but the HCV RNA test should be repeated after 4 to 6 weeks. Such patients are not immune to further infection.

Quick Reference Guide

The quick reference guide can be downloaded by clicking here.

Source: letter from Liam Donaldson, 27th October 2008

COPD Team Referrals

• Referrals to the COPD Team should be made on the form that you can download by clicking here, and sent to:

Fax: 0115 8786372
Post: COPD Team, Clifton Cornerstone, Southchurch Drive, Clifton, Nottingham NG11 8EW

Our named COPD Nurse is Brian Rorison - contact no. 07900 216768

Source: email from Brian Rorison, September 2008