Severn Pharmacy's Ajay Berry talks about the ear infection service on offer, and how it's helping patients who can't get to see their GP

Service type: Ear infection.

Name of pharmacy: Severn Pharmacy, Oadby.

Name of pharmacist: Ajay Berry.

How long have you been offering this service? Since 2019.

Why did you start offering the service? Patients were struggling to get GP appointments, so we looked at PGDs that we could offer to help people with basic medical problems such as earache.

How much did it cost to set up the service? The cost for the individual PGD is around £39. [There is also a time cost] - you have to release yourself from the pharmacy to offer these PGDs, you have to have trust in your staff and you have to train them to be able to take over all the pharmacy jobs, such as ordering, looking after patients, and contacting GPs, which a normal pharmacist would have done before.

What, if any, training did you or other team members have to undergo? After purchasing the PGD and going through it, you are expected to do some work on your own at home, before signing a declaration of competence. So, I did some research online about ear infections, what to look out for, and the symptoms. Once I was happy that I could diagnose people with an ear infection and also follow the PGD, I signed the declaration.

In a nutshell, what does the service involve? Firstly, we have to determine what age the patient is, because we can only provide the service if they are aged two and above - and if they are under the age of 18 then we need permission from a parent or guardian to carry it out.

We are provided with a form as part of the PGD, which includes a series of questions we need to go through with the patient before proceeding. For example, if they are pregnant or breastfeeding, if they have diabetes, or if the presenting ear infection or earache is recurrent, then we can’t go any further.

Once the patient has agreed that none of these [the exclusion criteria] are applicable, we go through more questions about their symptoms. This includes discussing where the pain is, whether or not they have any discharge, how long they’ve been experiencing symptoms for, and if they’ve had any problems with earwax or infections before. I also have a torch so I am able to look into their ear and see if there is any discharge. The list of questions we have to go through is substantial, so this consultation is not something that happens in five minutes, it takes at least 20 minutes.

If the patient has an external infection, then we can offer an over the counter spray called EarCalm, which is licensed for outer-ear infection.

If the patient is experiencing pain going down the canal, all the way down the throat and even sometimes towards their tooth area, then it’s possible that the infection is internal. In this case, the PGD allows us to give Otomize Ear Spray without a prescription, providing there are no contraindications and no previous history of serious reactions or side effects to the medication.

Finally, if appropriate to do so, we would notify the patient’s GP.

Are there any opportunities to sell over the counter or prescription products during the consultation or after it? Yes - there are some possibilities for link sales. There is a Chinese candle called Otosan, which cleanses the ear, and if the patient is swimming, then we can provide swim drops.

How have patients responded to the service? The feedback has been good. Most people who have had the Otomize ear spray have come back to the pharmacy at some point, a month or so later, to pick up a prescription or just to come into the shop, and so I’ve asked for some feedback. They’ve all said something like ‘oh yes it [the spray] worked wonderfully, I used it for 7-10 days and it all disappeared’.

Roughly how often each month do you carry out the service? We see around three patients each month.

How much do you charge for the service? The consultation is free and the patient pays for the spray if they need it. We charge a mark up on the cost of the spray - if you’re only making one or two pounds on it then it’s not worth doing it. So, we charge patients a bit more than the nine pound prescription charge, to take into account our time and efforts, and all the reading and education we have done to set up the PGD.

Roughly how much a month do you make from offering the service? Figures not available.

Would you recommend offering this service to other contractors? Yes certainly, but this does take time and effort - it’s not something you could just do without thought, or without training your staff beforehand.

You also need to have a reasonably-sized consultation room. One of the counters in my consultation room can lift up, so if I need to examine the patient’s ear, I can lift the counter up and do this, put the table back again, and continue - rather than going out through another door, which adds time.

As contractors, we are all so involved in our pharmacies, so we can’t just suddenly think ‘I’m going to offer all these PGDs’ because it won’t happen. If it’s rushed, then it won’t be a proper PGD. There needs to be a thought process - is the consultation room appropriate, are staff adequately trained, and how can you release that time for you to deliver the service.