Community pharmacies that have ordered but not yet received an otoscope may begin offering the Pharmacy First service from 31 January without the otitis media clinical pathway.

This comes in response to reports of pharmacy owners struggling to get hold of otoscopes, The Pharmacist understands.

NHS England (NHSE) made the concession in a letter to pharmacy contractors and other healthcare providers, published today.

It confirmed that the service would start on 31 January 2024, and said that more than 10,000 community pharmacies had already signed up.

The new national Pharmacy First service in England will see patients able to access advice and treatment for seven common conditions – sinusitis, sore throat, earache, infected insect bite, impetigo, shingles, and uncomplicated urinary tract infections in women – from participating community pharmacies.

The service specification sets out that an otoscope must be used for ear examinations as clinically indicated within the acute otitis media pathway.

Before commencing the service, pharmacies must have an otoscope and have trained their staff providing the service in using it, according to the service specification published in November.

But today NHSE said that as long as pharmacies can prove they have ordered an otoscope and are awaiting delivery, they may begin offering Pharmacy First without the acute otitis media pathway for the time being – a concession welcomed by the sector’s negotiator.

Dr Leyla Hannbeck, chief executive of the Association of Multiple Pharmacies (AIMp) also told The Pharmacist that she welcomed the allowance. But she added that while AIMp members were 'dedicated to delivering this service successfully', the group was continuing to ask 'that the authorities engage better with frontline healthcare providers to understand the realities of delivering to ensure it is successful'.

Pharmacies must have an otoscope and be able to provide the pathway from 1 April 2024, NHSE said.

This does not apply to distance selling pharmacies, which are exempt from providing the acute otitis media pathway.

NHSE guidance said the otoscope must be reliable, easy to use, and compliant with MHRA safety standards.

And it must have:

  • An LED (preferred) or halogen light source with adjustable brightness.
  • At least 3x magnification lens
  • A wide-angle lens
  • A range of disposable tips, from paediatric to adult sizes.
  • A hard case for keeping at least otoscope head, handle and specula
  • A comfortable, non-slip handle suitable for both left and right-handed users.

It must also be lightweight, durable, liquid splash resistant and made of medical-grade materials that can be easily cleaned.

And to comply with UK regulations it must have a UKCE mark and meet or exceed the standards laid out by the MHRA.

‘Meeting ISO standards for medical equipment (like ISO 13485) adds an extra layer of assurance,’ the NHSE guidance added.

It also recommended that the otoscope has manual focus adjustment, an option for cordless use, at least a one-year warranty, user manuals or even online training modules for pharmacy staff and reliable customer support from the manufacturer or supplier in case of issues or queries.