Service case study: Southwest London Hearing Health Pilot
Twenty community pharmacies across South West London have participated in a Tympahealth (hearing health) pilot. The pilot aimed to test the provision of a more efficient pathway for ear health care that could be delivered away from secondary care, reducing outpatient spend and providing better quality care at a lower cost. The service launched in July 2022 and ran until 30th June 2023.
Trained staff (including pharmacists, pharmacy technicians and pharmacy assistants) at participating pharmacies used a 3-in-1 innovative otoscopy device, which enabled screening hearing tests, digital otoscopy and wax removal to be performed in local community settings.
Background and context
There is a lack of accessible NHS (free) ear-wax removal and hearing assessment services in Southwest London. Ear wax removal, while provided in some GP practices as a local Enhanced service, is not part of the general practice core contract. The availability of the service is, therefore, variable due to capacity constraints and non-standardised local commissioning arrangements.
Patients as a result, can face long waiting times for secondary care appointments or may be directed to seek private treatment. This gap in provision contributes to health inequalities, Ear Nose and Throat (ENT) patient backlogs and poor value use of senior ENT clinicians’ time and skills when time is spent on wax removal (which could be performed by non-medical staff and in non-acute settings at lower cost).
The pilot sought to:
- Support reduction of inequalities;
- Upskill the community pharmacy workforce to deliver ear health care assessment supports; and
- Provide digital otoscopy via a device where a video of the ear can be taken and saved for review by consultants, providing a more efficient pathway for senior review.
Scope of the service
The pilot was for patients with hearing-related problems. Patients were only referred to the pharmacy service via a GP or other member of the clinical team, such as a patient navigator. Once they met the inclusion criteria to attend the service, the patient was referred to one of the community pharmacies for an ear health assessment and potentially treatment. Appointments lasted an estimated 20-30 minutes.
The service was set out in two tiers. Tier 1 of the service provided an initial clinical assessment which consisted of:
- A consultation; and
- An ear canal(s) examination (an otoscopy procedure) using the Tympahealth device.
Tier 2 of the service, followed the examination, if the patient was assessed as requiring:
- Ear wax removal from one or both ears (micro suction via the Tympahealth device);
- Audiologist assessment (remote service);
- A hearing screening test; and/or
- A referral back to general practice if the problem could not be resolved. The GP could then decide to treat the patient or refer them to secondary care depending on the presenting condition.
Potential impact
If fully commissioned across Southwest London, it is anticipated that the service could provide:
- Faster reductions of the ENT backlog; reducing the number of appointments required to resolve patients’ issues;
- Reductions of local health inequality by providing more access to free ear health services;
- An improved patient experience, with faster care and care delivered closer to home;
- Upskilling of staff to perform ear health services, helping to release the assessment-stage bottleneck of the ear health care pathway; and
- An estimated net system cost savings of up to £1.2million in the first year (non-cash releasing).
Speaking about the service, Amit Patel, Chief Officer of Sutton, Merton and Wandsworth LPC, said:
“Empowering our community pharmacies with the tools and skills to address pressing ear health needs not only elevates the patient experience but showcases the dynamic and adaptable role of pharmacies in the modern healthcare landscape.
“Collaboration has been the linchpin of this initiative pilot’s success. The remarkable teamwork between the Integrated Care Board, the Trust, and Local Pharmaceutical Committee has co-produced a service that goes beyond just savings.
“We have elevated the quality of patient care, drastically cut down waiting times from 25 weeks to just four and brought essential services right to the patient’s doorstep.
“This pilot exemplifies what can be achieved when dedicated organisations including the commissioner, providers and representative organisations come together with a shared vision for the community’s wellbeing.”
More information on the Southwest London Hearing Health pilot can be found under the Ear, Nose & Throat section on the Community Pharmacy England Services Database.
