Rob Cousins, independent prescriber and superintendent pharmacist at Insync Healthcare Pharmacy in Llanishen, North Cardiff, talks to Saša Janković about his private earwax removal service.

Service type: Earwax microsuction

Name and location of pharmacy: Insync Healthcare Pharmacy, Llanishen, North Cardiff

Name of superintendent pharmacist: Rob Cousins

Why did you start offering this service?

I got my IP qualification about seven years ago and have used it to prescribe for UTIs and I also run an acute conditions clinic on the NHS, but the main thing I have become known for is helping customers with earwax problems.

With about one in every three people the problem is simply ear wax with no infection, so running this clinic means I don’t have to send them to the audiologist just for earwax removal. It was always on my radar to do this as a private service because the demand is there, but I advise patients that if it turns out there is an infection present after I have removed the wax I can of course refer them back to the NHS service to treat the infection. We started the service about a year ago.

How much did it cost to set up the service?

I already had a well set up consultation room as we run a travel clinic here, so the only additional costs were training and the kit to run the service – including the USB otoscope I use, which cost about £30.

In a nutshell, what does the service involve?

I use a camera to check the patient’s ears. If there’s ear wax we can remove it, but if not then I refer them back to the NHS for further investigations and treatment.

Earwax can go rock solid like bullets, and it can be particularly bad in carpenters’ and plasterers’ ears that get full of dry dust. I also do a lot of right ears on delivery drivers who drive with their window open, as well as gamers and people working from home who wear headsets for long periods of time.

If we see wax I’ll book them in for a microsuction appointment about a week later and tell them to put olive oil in their ear in the following days. I use a USB otoscope which is a camera with a torch on the end so I can show the patient what’s inside their ear. This is really useful either if you need to tell the that there is nothing in their ear, or if there’s lots in there like the ends of cotton buds. I can also email the photos to consultants if needs be, as well as using the NHS Teams email system that we have in Wales which enables us to make a Teams call to another to NHS email address so they can see what I am seeing at the same time through screen sharing.

How have patients responded to the service?

Feedback from the service is really positive and people like that they can just walk in and I can look at their ears. I don't charge if I can’t get the wax out, and if they have to come back a second time I don’t charge.

Roughly how often each month do you carry out the service?

I see three to four people a week.

How much do you charge for the service?

The fee is £60 for two ears, which takes 20 minutes.

Would you recommend offering this service to other contractors?

Yes, but my ethos is I don’t go all in on one service. All it takes is for someone else to start offering the same thing locally with more money behind them and your own service can drop off. I do a bit of everything, so if one service has a dip – like my travel clinic in the pandemic – I’m not sitting here twiddling my thumbs and not affected by local variances.