Abstract
Many NHS Trusts are currently experiencing severe financial problems, with many resorting to compulsory redundancy for staff in order to balance the books. In 2005 the Department of Health (DH) introduced a system of payment by results (PbR), by which health care Trusts charge the Primary Care Trusts (PCTs) for the care and ser vices they provide. PbR represents a dramatic change to the way in which funds flow through the health care system. The aims of PbR are to ensure services are appropriately rewarded while creating financial incentives for Trusts as well as to 'support wider reform'. This system is based on a series of codes and has pushed the role of clinical coders to the fore in NHS Trusts. Every patient contact with the Trust, every diagnosis and every procedure performed generates a particular code from which a predetermined fee can be calculated.
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