Four community clinics, one shape

Dentistry, ophthalmology, audiology and podiatry run the same way: a caseload with a risk-based recall, a clinical score that means something, and a claim or an exemption at the end. The scores are what make them different.

1 Four services that look the same from a distance

Community dentistry, ophthalmology, audiology and podiatry all run the same shape of service: a caseload with a recall interval on each person, a clinical assessment with its own scoring, and a claim or an exemption at the end. Get that shape right once and each of the four becomes a set of differences rather than a separate system.

What they don’t share is the clinical detail, and that’s where a generic “community services” module falls over. A BPE score isn’t a PTA4 average and neither is a SINBAD score.

2 Dentistry: the recall interval is the clinical decision

The caseload carries last attendance, next recall, exemption and balance. Recall isn’t a fixed six months for everyone — it’s risk-based between three and twenty-four months, which is what NICE asks for and what most reminder systems ignore. Exemptions sit on the row too, so a patient on full HC2 support and a patient with a £73.50 band two charge are both visible before anyone starts treatment.

Behind the caseload sit the odontogram, BPE charting, treatment planning and the FP17 claim with its UDA count. The claim comes out of the treatment that was recorded, so the activity return and the clinical record can’t drift apart.

3 Ophthalmology: a sight test that knows what it’s screening for

Same shape, different clinical spine. Visual acuity, refraction and intraocular pressure, GOS vouchers one to six, and the pathways that change the recall: glaucoma, age-related macular degeneration, the diabetic eye screening programme. A patient on the glaucoma pathway gets twelve months instead of twenty-four, and the row says which pathway they’re on and whether they’ve been flagged to hospital eye services.

Imaging — OCT, fundus photography, visual fields — and the certificate of vision impairment and low-vision route sit behind it.

4 Audiology: two ears, measured separately

The register holds the aid type, the four-frequency pure tone average for the right and left ear separately, the hearing loss band, the last review and whether a battery request is outstanding. Hearing is not symmetrical and a single average would hide that; 58dB in one ear and 63 in the other is a different conversation from 58 in both.

The outstanding battery column looks trivial and isn’t. An aid with no batteries is an aid in a drawer, and the person stops hearing without anyone recording a clinical change. Tinnitus and balance, hearing aid fitting, and the IOI-HA outcome measure sit on their own tabs.

5 Podiatry: the score that predicts an amputation

The diabetic foot caseload is banded low, moderate, high and urgent, with a SINBAD score out of six on each row and the care plan written out in a sentence anyone can read: three-monthly review with offloading insoles and vascular monitoring; weekly wound review with intravenous antibiotic liaison and a vascular surgery referral pending.

The urgent row scores six out of six. In a diabetic foot service that number is the difference between a wound and an amputation, and having it on the caseload rather than inside a note is the point of scoring it at all.

Where it lives in commvita