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Investigation and Learning from Deaths in Community/Primary Care

Fri, 14 Jun 2024

Virtual, Online

Follow the conference on X #Learningfromdeaths

This conference focuses on investigating and learning from deaths in the community/primary care. 

By 2024, all deaths in the community or acute settings that do not required to be referred to the coroner (non-coronial deaths) will need to be scrutinised by a medical examiner. The conference focuses on the extension of the Medical Examiner role to cover deaths occurring in the community and the role of the GP in working with the Medical Examiner to learn from deaths and to identify constructive learning to improve care for patients.

"The majority of in-hospital deaths are now scrutinised and the process is rolling out to include all community deaths. It is expected that the process will become statutory by 2024 when every death within England and Wales will be reviewed either by the Medical Examiner or HM Coroner."

The Medical Examiner: reviewing all non-coronial deaths in England and Wales, July 2023 (https://doi.org/10.1016/j.mpdhp.2023.04.001)

“Medical examiners will look at causes of all deaths not investigated by the coroner to help prevent criminal activity and poor practice… Medical examiners will strengthen safeguards by scrutinising how people have died prior to registration and make sure the right deaths are referred to coroners.”

Department of Health and Social Care 14th December 2023

“The move to a statutory system in 2024 will further strengthen those safeguards, ensuring that all deaths are reviewed and the voices of all bereaved people are heard.”

Dr Suzy Lishman, Senior Medical Adviser on Medical Examiners for the Royal College of Pathologists 14th December 2023

 This conference will enable you to:

  • Network with colleagues who are working to improve practice in the investigation and learning from deaths in the community 

  • Reflect on the lived experience of a carer on how we can best involve bereaved relatives 

  • Understand the role of the Medical Examiner in Primary/Community care and how they can support GPs

  • Update your knowledge on the Patient Safety Incident Response Framework (PSIRF) 

  • Understand national developments and national reporting and notification requirements, including the advice from a current Coroner

  • Identification and reporting of deaths and the role of the Medical Examiner 

  • Reflect on how you improve involvement of families and carers

  • Effectively support staff when a death occurs including supporting staff through coroner inquests

  • Self assess your learning from deaths process and ensure investigations lead to change

  • Supports CPD professional development and acts as revalidation evidence. This course provides 5 Hrs training for CPD subject to peer group approval for revalidation purposes

Speakers include:

Mr Mike O'Connell

Legal Services Practitioner and Interim Senior Inquests Manager
Calderdale and Huddersfield NHS Foundation Trust

Dr Jason Shannon

Lead Medical Examiner, Wales
NHS Wales Shared Service Partnership

Mr Julian Hendy

Co Founder & Member and Founder
Making Families Count CIC

Ms Nadia Persaud

Area Coroner
East London
Her Majesty's Coroners East London

Exhibition & Sponsorship Packages

This conference offers a valuable opportunity for industry suppliers to personally meet with their target audience where they will have time to talk and demonstrate the benefits of their products. High quality specialist audiences make having a presence at our events a highly targeted and cost effective marketing channel.

Why Exhibit?

Having a presence at this event will give you the opportunity to:

  • Demonstrate your product, system or service
  • Network and engage with your key audience  
  • Generate new business leads
  • Gain exposure for your brand and raise the profile of your organisation
  • Understand the current needs of your audience and challenges they’re facing
  • Update your knowledge of national policy and local developments  


Contact Sarah Jane for exhibition and sponsorship prices, or to discuss a tailored package to suit your needs and budget.

Fee Options

Virtual NHS, Schools, Care and Public Sector



Virtual Voluntary sector & charities



Virtual Commercial organisations



(Prices in brackets include VAT)


Additional delegate discount:

A discount of 15% will be applied to fees for any extra delegates.

Online discount:

A discount of 10% will be applied if you pay using the website.

Also of Interest

Supporting Organisations

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