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Okay. Hi, everyone. Welcome to the new Finance Webinar today on how the NHS works. We'll just give it another few minutes and we'll get started. Okay? I think we'll get stopped it now. So, like I was saying, the Webinar today is on how the NHS words on. I'll leave Sira and James to go through the rest of you. Okay. Thank you very much. Good evening, everyone. Um Oh, come to a another webinar on personal primer. Wrong. Doctor Sai Rasha. Just want to remind everyone if you have any questions at all as we go through, please posted in the comments. We've been really enjoying all the questions on kind of the back and forth interaction that we've had over the last few weeks. So a great job keeping coming. Um, on now it's my pleasure to hand over to Dr Fire Asher. Qualified chart of the count on Academic before I one. That's nothing in general surgery in the oxytocin, every are over to you. Lovely to see you guys. Uh, I'm Dr Sara Absher. As as James mentioned. Um, on today, we're going to be talking about something a little different. So so far, we've been covering your personal finance. We've been covering things like the credit score we've been covering, um, savings accounts, um, all sorts of things like that. But today we're going to talk about the NHS, which is where we're gonna be working for a very long time, spending a lot of our lives here, Onda. No matter how we think of ourselves in the big picture, off the NHS, every little thing we do matters. It matters to us in matters to our patients on it matters to the infrastructure that is the HS. So I'm going to tell you a little bit about the structure, and we're obviously going to see it from a money side of things, cause that's why we're here. Um, I'm gonna talk to you about how hospitals get their income. Um, because you might not. You might know how it works. Actually, I didn't until I was actually working in one of the finance teams. Whilst at medical school. I didn't even I thought I knew, but it's actually very complex told to me in a very nice, simplified way, which is how I'm going to tell you guys. So I do apologize if any of you actually really know the ins and outs, and I'm simplifying it too much. But the one thing I really want to communicate to you tonight is the importance off coding what that means, how you're involved in it, because you are actually on. But we can do so let's just jump straight into it. That's me. Um, you know me very well right now, so let's go. So any chest, any chest is everything under the Department of Health and Social Care. Um, it's running now by surgeon. Job it on. Um, you might recognize some of these Ah bodies. Um, health education, England. That's us under them. Public health. England. Um, my recognize any chest England I just improvement are the commissioner's commissioners are the bodies that actually, um, commission or by services on any just hospitals where we're gonna be working on any just GP practices are called providers there at after a bit more of ah, some tables there, there at the bottom, there of actually the front line service providers. All of these bodies are like leading body's off these these areas. We're not going to go over any more of how these these ones work because what I want to talk to you about is when you're working in a hospital as a foundation doctor, your hospital is going to need to receive income for all the patients it treats, Um, and for all the services that it provides. So what happens is, first of all, let's let's take surgery. For example, Let's take your surgery. So, um, a decompression is performed by a surgeon. The responsible surgeon completes the notes on whatever system they have. Where I was in Coventry, they used a system called opera. They might use a different system elsewhere in the hospital that you might be in. Those notes are then interpreted by coders. We'll talk a little bit more about who code is all, but what they do is they take the notes that are written in a clinical format, um, by the surgeon, and they translate them into codes. The's codes are pre prescribed by the CCGs, the critical commissioning groups who are at the top of the pyramid, off each of several different hospitals and trust in an area. Onda, um, we basically submit are codes to say we have done these procedures. We have done these services. Please. Can you pay us for them? On those codes Will attract a certain tariffs. Tariff is the amount we're being paid. Um so then the codes of processed they split into different hospital resource groups, which then make up a finished consultant episode are finished Consultant episode is saying the neurosurgeon consultant has led a particular procedure in the hospital resource group was nursing stuff Was ward staff was water overheads. Um, all of those come together into the episode that the consultant was involved in, be that that data is then sent to the CCG, Um, and then they convert it into something called spell level, which is patient based. S 01 patient has spent several weeks in the hospital because of something quite complex. They've been seen by lots of different consultants, and lots of different members of star on all of that will be put together under their spell. That's the spell of time that they spent in the hospital. Um, and then when the income comes back, it's actually a portion to the dominant specialty. So the specialty that saw them the most. So say you've got someone who's in the hospital that quite complex. They have a cardiac issue, and they are diabetic. But they're also requiring your surgery for, um, cranial hypertension, carino hypertension. They will be treated by the neurosurgeons for that, but they will also need the diabetic consultant to come and make sure they're all right on there. Also need, um, the consultant. The cardiologist. Come in, check. They're all right. So when the income comes back, it's not actually going to be split between those consultants. It's going to actually go to which have a consultant saw them the most. In this case, this is probably gonna be the neurosurgeon. Um, on then, lots of factors are assumed in in that. So when we send the codes over it, no only includes the service. It also includes the costs of us. Um, all the juniors were working and helping out in the woods, or the consultants are spending time in the woods. So the income that's being generated isn't actually a true reflection of the income being generated. It's, um, like a coded, broken down level. Um, income that has lots of assumed factors in it has has lots of different things. Feeding into it, Um, on the most important thing. I need you to get out of this because I'm sure none of this actually matters to you. And that is fine. Is that your operative notes the operative notes that are being done by that surgeon at the front. I'm going to dictate all of this. They're gonna dictate which codes the code is put in there gonna dictate which a charges they're going to be involved with. And they're going to dictate how much income they get back in the end. And it all starts with nuts. So let's simplify it. The large sausage machine where all of this information goes in. It's called a group A. It's just a nice program that does it for them on it pops out these codes. They're then sent off of the CCG. We don't need to worry about anymore. Good. So coding this. This is what I want to focus on clinical coding. So every hospital will have a team of codas. They Ah, very good at what they do. Um, they are well versed in using the coding manuals to then translate notes into codes. Um, so things like I CD 10 my CD 11. Those kinds of codes have been assigned a certain value by CCGs. So if you've got diagnosis and it's then translated into its I CD coach, that code is then sent off and certain amount of money comes back for it. So this is what they're doing. The important thing you need to remember is the's coders aren't medical professionals. They don't understand jargon. They're not going to be able to translate badly written notes. They're not going to be able to read between the lines. They're not gonna be able to interpret results do then make the code available for them on the problem. Most, if not all, hospitals have DNA, just hospitals is that they are no claiming back for how much work there doing because not all the notes are written in a way that cold is concluding. We pluck out the information that they need uncalled for it, which means most on I think pretty much all any. Just hospitals are losing money because they're no able to claim back for everything that they've done. Um, especially say you're you're in a m. You you see a patient for a particular problem. You're most likely going to be writing down the relevant past medical history. You're not going to writing down all of their core morbidities like eczema if it if they've come in with a headache. Um, but actually, if you wrote down examine the coda could then claim for that on we get money back for treating someone with eczema. Um, not for eczema. Just that the fact that you have Excellent. Um So what I want to talk to you about is clear notes. But actually how they should be clear, Because I could just shout clear notes and that, you know, it's it's quite vague, but they're actually quite specific things I can share with you to try and improve these notes. So more about code is before we go on, they can't make any assumptions. Um, they can only code for what is actually recorded on. It has to be in a particular diagnostic vernacular. That much is their manual. So, for example, um, I don't know. You could say hi, IBM I We all know what high B m I means, but they can't claim for high b m I. They can claim for morbidly obese, overweight obese because those all in the coding manuals, So you have to know roughly what to write for them to be able to code for the right things. They can't record anything with a question mark. It's so so common to see very sepsis. Query this on. We'll go on. We'll have a management plan. Patient will be treated. Everything we find. We'll be discharged. Um, but we can write that diagnosis down because it's not clear it's not clear what their diagnosis. Waas um, they can go through patient data to find out what it waas. They can't go through their notes. They can only go through what's given to them at that particular time so they can't fit in any gaps. Um, this is especially relevant for things like repeat all revision surgeries or if patients have had to come back for that particular reason. If we have to do a revision surgery, we get paid more. But if it's not written clearly in the notes on D, the total can go through and actually see Oh, this is they've had this before. They aren't able to code for a revision on. We lose on that money so That's why I'm trying to do this session to try and explain how that comes into play on how that would work. Um, on the reason this is important. I understand. You're probably think, Oh, well, I'm just gonna make the hospital more money. Well, it's not gonna How is this gonna benefit May? But what it actually does is the more the hospital can recoup the costs that it's spending, the more it can actually reinvest in itself. Which means I t systems, computers, the facilities that provided the the offices that are provided they can. All that money can be spent on that, and actually, we will benefit from that. Will benefit from having better equipment, will benefit from having better computers, faster computers. So actually, it's not just all we're making the hospital money, because all any chest hospitals are not for profit. So they know they're not giving this 20 shareholders. They know they're not giving this money, too, as as a prophet, they're not lining their pockets with it. The money is being put back into the hospital. So, actually, if we care about where we work on, we care about what? Where we work looks like doing this will help us get that money back in order for it to be reinvested to have a nice hospital. And that's why we're doing this. And the more we can do this, um, the better the hospital will look, which is more like the better of the funding it will get on that directly benefits us a swell cause we'll get more training opportunities, will get more recognition. And it won't be us a zone individual. But as a hospital, if we have a good reputation, will attract talent and you'll get to work with that talent. So it does in the long run benefits? I think so. We just went through a little bit. Um, why does it much to you? Um, So I'm just gonna jump straight into an example off. Um, what an example would look like. So say, uh, on the on the first column you've got here, the reason the person came in, they had cystitis. Um, yeah. Fair enough urine, am you? You're not gonna write down all this other stuff like they have diabetes without complications. Um, you know, things like that where you feel like it's non relevant they've got cystitis. They've been treated for society's. That's fine. Um, then that code will be generated. Um, on. Then it will be coded. Is kidney or urinary tract infection on the base? Tariff is what the code attracts. Tariff is just literally the value off the code. Um, and that's how much money will get back 1376. Now, if we recorded that core morbidities, we'd get Buck 2245. Nothing's changed about the patient or we've done is we've added their core morbidities on them, then know, even though it might not be relevant. I mean, the diabetes, I think, might be certainly well, but, um, we might not Might even think to put those down. Um, but actually, the code is will then be able to recruit the costs for us on. We'd end up getting more money for treating that patient because they were a more complex patient than was being shown before. So these kinds of things will. These little changes will help generate more income a lot more income than you think. So next time you're clocking a patient and they're telling you that past medical history on they go. 25 years ago, I had my gall stones removed. Or you know, what other then you know that they've had they've they've had gallstones, you know that they all prone. So that kind of thing that might tell you that they may be, um, have other issues that then you might want to explore on by understand, like we're all struck for time on that can be quite difficult. Teo, you know, get a little history we really like. But whatever you do manage to get just jot it down on just dropped it down in just clear simple times because you might be surprised how much they can actually recoup from the information you've put down. Um, so another example is off terminology. Um, so code is, uh, if you're unsure about the diagnosis they can use, like, sales person comes in on. Do you think it's a migraine on your pretty shorts and migraine? You right? Diagnosis migraine. Perfect code is Come use that. But if you're unsure, um, that's okay. You don't have to have a definitive diagnosis. You can say treated us. You can say the presumed diagnosis that you could say working, diagnosis? Um, probable diagnosis. But then finally, enough. You can't use differential, and you can't use possible how weird that you can't use possible. But you can use probable. Um, no. Not many people know that. I don't think, you know, apartment coders. I don't think we're ever told what terminology we can or can use. Um, Onda definitely can't say anything with a can't Can't use anything with a question mark, which I am in. So I have a really bad habit off writing query, whatever. Um, and I I will definitely be working on that one. But I didn't know that things like suspected suspected sepsis such a common way of explaining it. Such a know. I can't believe the amount times have said that. Um, but we we wouldn't be able to claim for it. How much income would be lose their That's awful on. The problem is, once that we've we've finished the notes on the patient's gone. That's it. That's our hands finished with it. Coders can't bounce back and say you could you just Could you change that? That's it that the incomes lost. Um, So if we can start dealing with the problem. Even before the notes have gone to the code is imagine how much more income we could we could actually generate. Um, just just by making these small changes. So if you take away nothing from this evening apart from, please just write treated as that that would that would be moving enough. Um, I think you'd be surprised just how much of a difference that would make. Um, on then, another thing I wanted to explain about test results, as I was explaining before that you can't that the coaches can interpret test results for you. Um, in the sense of then coding for them. I know it's really obvious. You might say, Well, um, I put Jeff are 23. What else do they need? They actually need it writing out that they've got Stage four CKD or B M I 20 summit so normal because it just sounds just more polite. Just just factually put their be MRI done. Why? Why do you need to make a big song and dance about the fact that they're obese? But coaches can actually claim for bm I, but they can claim for obesity. Um, again high tropes things like C CRP. If they've got high CRP, you can't just write high C CRP. It has to be, um, signs of infection signs of inflammation on. Then they can code for them. So sometimes when you're writing stuff down in the notes on your writing down results, just just take a second. Teo, simplify it and give it a word. Things like heart rate X one said just right tachycardia, BP. We just write hypertension on. I know it'll feel really weird doing it because it makes it it. It feels like you're just really simplifying it on. Obviously, everybody knows that. Ah, high BP is hypertension, so why would you need to write it down? But you're not writing it down for you on you're not writing it down for your colleagues, your clinical colleagues. You're writing it down for the coders on your writing it down for the hospital to be able to reclaim their income. And if you can try and see it that way, maybe it'll feel a little bit less jarring to do it. Because I I have been changing the way I I document things on it is, is really weird when you have to, like, spell out everything because it feels like Why don't Why am I not surrounded by people who understand this? Well, we all, um but code is on there, um, to tell us what they can and can't use. Um, and I'm a sit more. You do it, the more it becomes habit Onda. Actually, it will be just quite useful and a nice way to be able to simplify difficult concepts when it comes to you having to explain it to patients as well. You might find that actually, you're using less jargon and you're using simple language, which is what they like on it might just not be taken for granted as much when, um, when you're doing it this way. So, yeah, if if you take away nothing, please just take away that coaches aren't clinical, they don't understand. Um, well, they do understand they, but they can't make assumptions. So you have to be quite clear on what you're saying. Um, so I know this has been really quick and short because I did not want to income, but people with the structure of the NHS and how it draws down. It's money. That's not something we need to know. Um, all I wanted you to understand this evening was that you can make ah, hell of a lot of money for your hospital for what they're doing just by being more clear on your notes. So just make the diagnosis clear. Make sure that you write out your interpretations. Uh, make sure that you don't forget comorbidity ease, Andi, don't put any question marks or differential diagnoses. And even with those tiny, tiny little actions, you'll be able to make such a big difference for the coders on happy coders are really, really important. So just fly any questions, you've got to shoot them across. Um, on I will leave it to suggest is to let me know if they're already okay. Thank you very much. Sorry. That was really interesting On very informative, as always. Um, c is couple questions are their universal like codes or universal descriptors, like in a little different hospitals. Because coders come recognize? Is that the same across the NHS? Yes, it is. So I don't know why you'd want to do this unless you have insomnia and you need help. But you can actually get the coding manuals online. They are available online. Um, and they tell you exactly what terminology translates? What code? Um, Andi, they are really dry, but they can give you an idea off. What kind of terminology needs to be used, But thank you. That's a great question. That's that's really nice. Thank you. Thank you. And on other than Ms Seminar, I assume, um, do we get any training on this? But the ones that don't, That's that's why I thought I'd do this evening on this because actually, consultants don't even get training on this. Um, on they are running entire budget centers. They are making huge financial decisions on, um yeah, no training on this. Uh, when I was in, um, the Carpentry Country University Hospital, there was one consultant who had taken the time to understand why he wasn't being seen as profitable on He went and met with the code, is on one of the coding, manages very kindly start with him and went through his notes with him and explained what they would be able to claim for based on those notes. So then the consultant, when? But actually we did this time we did this on it was a revision on. We used these materials, and, um, in the end, we had to end up doing this. So based on the information today, she'll information that the consultant provided they were missing out on well over 10 10,000 lbs of reclaim a ble justifiable income because the notes haven't reflected that on. It's not because the consultant didn't care. It's no, because, um, you know, things were missing that were important. It was because they were just not enough clear information on there for the code is to be able to reclaim on the counseling. Had no idea that that's how it needed to be done. Um, so, yeah, there is currently no training on this, but I would like, hopefully, as our careers progress for it to be quite normal for us to have more training on this. Yeah, but if you make sense, um, and last question, um, given that this kind of done a whole lot like you. Lack of training, etcetera. Um, is this something that consultants are interested in? Would it be appropriate order or quality improvement project for incoming? If one's a Tues of learning about the coding and then weigh approved the profitability of this service. Like, do your applause your average in in Just consulted a care enough to supervise you and be Is it something that you think is easy enough to do? Some of that may be passes no chance of the counter If someone came up to you and when. How can I make you more money? I think you're very likely to to listen. I 100% saying it would be an excellent, excellent order. I don't even think you'd have to do that many samples. Um, and all you need to do is arrange some time with one of the coders on. They do most of the work for you in the sense of telling you exactly what they claims in the conclave. Um, I think it would make a phenomenal project. Something so unique. Um, yeah, I think it would be of fantastic project to be able to do. I don't see it as being very resource intensive. I don't think it would be very data intensive. Um, but I think the impact it would that would have would be huge. So pleased if you think that would be an interesting project? You want to talk to me about more about what it might look like or what you want? How you'd want a planet. I'd be so, so happy to help. I'd be so happy to help you design that project. Because if we had more people doing it in different hospitals, we could probably come up with something. A really good case to improve the training globally across the board for all of us. So, yeah. Do do you get in touch? If that's something you're interested in, I love to help. Okay. Perfect. So I believe your contact each other on the reminder B Web site. And I think my no big web site has its own kind of leave. A question. What suggestion? Type thing. So if anyone is interested in that, um, by all means get in touch. Um, okay. I believe that's a lot of questions we had eso final thing for me is just to remind a run. Please, please, please leave us some feedback things. You want more wrong things? You want less off? Be specific. Give us and things that we can improve on giving things we can reflect. One thing that we can use, not portfolios. We really appreciate it. And some of the feet, But we've had recently has been really good quality. So those of you already doing that, Thank you very much for me. Appreciate it. Um, anything else from you? So, uh, no, I think I'm just really grateful. People are still training in, um and I really, really hope it's helping. It is that's that's all. It's here for its to help you, um, on Don't really hope it's doing that much right now. Certainly learning 20. So Okay, great. Thanks, guys. I was really, really good. I just wanted to say Tune. And next week, Poor thinks I wrote about pensions next week, right, which is, like, incredibly, incredibly important. So people come next week on. I wanted to just say that I actually didn't order on coding last year at my old job on It's not. It's it's a lot of dull work, but afterwards we would have paper coding sheets. We just changed the layout of it, and I saved the department thousands of pounds on. There's no other way to get a consultant too, like you that much to to have you work on that a person, and it's actually it's not that bad to do. That is insanely cool. Oh, my God. Really in. So Yeah. There you go. Someone's already done it. You can do more, but Okay. Thank you so much, sire. On James. And thank you for listening and hopefully see you next. Street, I