Hassan Malik, owner and superintendent pharmacist, talks to Saša Janković about his ear syringing clinic at Carter’s Chemist in South Shields

Service type: Ear syringing.

Name and location of pharmacy: Carter’s Chemist, South Shields.

Name of superintendent pharmacist: Hassan Malik.

Why did you start offering this service?

We took over the Carter’s group of four pharmacies in April 2019 and started the ear syringing service that August.

At the time I heard that our local GP surgeries were trying to push away from offering ear syringing on the NHS, and indeed nationally the NHS didn’t want it doing unless it was done privately, so we thought we’d try offering it as a new service to our customers.

How much did it cost to set up the service?

Because syringing just uses water and no medicines are involved there are no PGDs to buy. The training cost £1,500, which was a full day for two of our pharmacists and two technicians.

What, if any, training did you or other team members have to undergo?

In order to offer the service we had to have official training from a healthcare provider, and a nurse had to sign us off to say we were qualified to carry out the procedure. We were each observed doing five syringes to check our competence and see how the ears were before and after.

Once you are qualified, if there’s no break in service provision there is no requirement to refresh your training, but if any point you stop for over a year you have to get recertified.

In a nutshell, what does the service involve?

It started off slow, but once Covid happened it really took off because doctors’ doors closed overnight and the pharmacy was the only place people could access this service. Word soon got out and we had referrals from local GP surgeries as well.

We wear full PPE for the consultation, which lasts 15-20 minutes, and it can then take an additional 20-30 minutes to do the syringing. The consultation is to find out if the problem is caused by impacted wax, infection in the ear, or dried skin. If it’s down to dry skin then olive oil in the ear canal will resolve it, but the majority of the time we find it’s impacted wax which needs syringing.

We have got a pharmacy technician who does the actual syringing, but you need to have a fully qualified pharmacist on the premises, and we both do the consultations. The customer has to fulfil certain criteria – for example, they can’t have had an ear infection in the last six weeks, and if they have had a perforated eardrum you are not supposed to syringe at all – so we go through a detailed consultation form with them, and lots have said this has been more thorough than at the GP surgery. Through this we have identified people who have had a perforated eardrum but who tell us they have had syringing done before on the NHS, so we have refused to do it.

Are there any opportunities to sell over the counter or prescription products during the consultation or after it?

In south Tyneside there’s a GP to Pharmacy referral scheme with the doctors so we can prescribe antibiotics for ear infections. Usually this involves the doctor referring the patient to the pharmacy for us to prescribe, but if customers come to us for ear syringing and we notice an infection we can call their GP and ask if it’s okay for us to prescribe on the service, and I’ve never been rejected.

Because we are not referring them back we can save a doctor’s appointment and customers get the antibiotic they would get from the doctor anyway. This helps build our relationship with the surgery and gives them – and the patient – peace of mind that they are getting looked after by us properly.

How have patients responded to the service?

Ear problems can be really painful, as well as affecting hearing and making it hard to sleep. When it comes to hearing loss, 90% of our customers who report it are elderly, and under normal circumstances they would routinely get their ears syringed at the doctors surgery, so they are used to having it removed. Indeed, since Covid there was a 6-week wait for ear syringing at the only one of the surgeries left in our area that still offered it, and people just don’t want to wait that long as it is affecting their quality of life – for example, many of them tell us that they can’t hear their family members on the phone or video calls, which is increasing their sense of isolation right now. They tell us they like the ease of access the pharmacy offers, and that we go through so many checks with them. Lots of them have told us they will return to use the service again.

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

Ear wax does come back, especially in the elderly, so people come once or twice a year. Pre Covid we were seeing about 4-5 a month, and now it’s about 20 a month.

How much do you charge for the service?

We charge £55 for both ears, or £50 for one. This includes a consultation fee of £15 to stop time wasters, which is waived if the ears need to syringed.

Roughly how much a month do you make from offering the service?

The equipment is disposable and expensive – it costs about £15 per appointment – so we make about £35-40 profit per patient, which is about £500 a month.

Would you recommend offering this service to other contractors?

Absolutely. Plus our technicians love it as it opens doors for them to be trained in new things, gives them a chance to meet customers they wouldn’t otherwise meet, and changes their routine as well. We are not doing this for the profit but to bring new people to the pharmacy, which has worked. We are the only ones in the area doing this service, and we have definitely noticed that people are changing their pharmacy to us, having encountered us through it.