A pilot using community pharmacies to deliver comprehensive ear care has improved patient waiting times and accessibility and has empowered pharmacy teams.

But to make such a service sustainable, the fee paid to community pharmacies must be ‘realistic and viable’, an evaluation of the pilot has warned.

And with the pilot due to end this month, the local pharmaceutical committee (LPC) has told The Pharmacist that it doesn't yet know whether the service will continue on a larger scale.

The pilot was developed by NHS South West London Integrated Care Board (NHS SWL ICB), in response to a ‘lack of equitable and free NHS hearing health services in the area’, according to the pilot evaluation report, which was published by Health Innovation Wessex in January.

‘This can lead to patients facing long waiting times, health inequalities, and increased secondary care backlogs. It can also mean that senior ear, nose and throat (ENT) clinicians’ time and skills are not being used as efficiently as possible,’ the report said.

Over the 12 month course of the pilot, from September 2022 to 2023, 7,648 patients were referred by 72 GP practices to 20 participating community pharmacies in the area.

Over one third of patients (36%) were seen within one week, and 87% within four weeks.

On average, patients waited 14.4 days from their GP referral to community pharmacy contact, with nine in 10 saying they were offered an appointment in pharmacy sooner than they expected.

Trained pharmacy staff were then able to perform digital otoscopy, earwax removal and hearing checks on patients using a three-in-one otoscopy device (TympaHealth).

Some 85% of patients treated received digital otoscopy followed by microsuction earwax removal and/or a hearing check.

And 70% of referrals (5,353 patients) were able to complete their treatment in community pharmacies.

Meanwhile, 193 (3%) completed appointments resulted in a recommendation for the patient to be referred through their general practice to secondary care, including ENT or Audiology.

All patients (100%) surveyed said pharmacy staff clearly explained the procedures that were carried out, while 98% said staff clearly explained what would happen after the appointment.

And nearly all (99%) said they were happy with the service received, while 98% would recommend to family and friends.

Almost all (95%) professional stakeholders also said their experience of the service was ‘good’ or ‘very good’, and the majority said they would recommend implementing it elsewhere.

The evaluation report suggested the pilot generated ‘potential cost savings (non-cash releasing) when compared with delivering similar activity in secondary care’.

But it noted: ‘Current payment structures should be reviewed to ensure they remain viable for supporting community pharmacy participation.’

Community pharmacies were paid £15 for an initial consultation and examination, and then a further £20 for earwax removal, a hearing check or a referral back to general practice.

They were not paid for further follow up appointments, or if a patient did not attend, which happened in 13% of referrals, and which the report noted as a potential hinderance for community pharmacy participation.

‘Some concerns were raised amongst community pharmacy staff that the current payment structure does not necessarily make it sustainable to provide the service in the long run and may therefore make it difficult to attract new pharmacies to participate in such a scheme if this has not been addressed and rolled out further,’ the report added.

For future commissioning, and if the pilot were to be adopted elsewhere, the report recommended that a ‘realistic and viable’ local payment structure be agreed ‘to ensure sustainable future delivery, and to avoid overburdening pharmacy staff.’

Amit Patel, chief executive of Community Pharmacy South West London, told The Pharmacist: 'This ear health check pilot in Southwest London represents a monumental step forward in community healthcare, not just as a concept, but as a proven model of success.'

In addition to improving waiting times for patients, the service 'underlines the strategic shift of activities 'left', bringing essential services closer to home', he said.

'The value we've demonstrated through this initiative is immense, showcasing a scalable model that can profoundly impact health service delivery. It is my firm belief that expanding this service is not only beneficial but necessary. The pilot has laid a robust foundation for what could be a transformative change in how we approach and deliver healthcare services in our communities', Mr Patel added.

But he said that with the pilot due to end this month, the LPC had as yet heard nothing about whether it would be commissioned on a larger scale.

As part of Pharmacy First, community pharmacies in England can now offer acute otits media treatment for patients aged one to 17 under a nationally commissioned patient group direction.

Following reports of pharmacy owners struggling to get hold of otoscopes, NHS England (NHSE) conceded that community pharmacies that had ordered but not yet received an otoscope could begin offering the Pharmacy First service from 31 January without the otitis media clinical pathway.

The chief executive of the Company Chemists’ Association (CCA) has suggested Pharmacy First could be expanded to help fill gaps in NHS earwax removal provision in England.