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Ear care service: ‘I’m trying to be accessible for as many people as possible’

ear syringing

By Saša Janković

25 Jan 2021

Bharvi Patel, IP pharmacist at Apple Tree Pharmacy in Chelmsford, tells Saša Janković how the Covid-19 pandemic led to her setting up an ear care service.

Service type: Ear care.

Name and pharmacy: Apple Tree Pharmacy, Chelmsford, Essex.

Name of (superintendent) pharmacist: Bharvi Patel.

Why did you start offering this service?

I started offering this service in autumn 2020. Our most popular private services are usually chickenpox, meningitis B and travel vaccinations, but once Covid-19 hit we had six months where we couldn’t run any private services at all. Then, as things eased and we got PPE I was able to start up our clinics again, and at the same time I noticed an influx of patients coming in with prescriptions for antibiotics for ear infections.

Because, as part of the Quality Payment Scheme, all our staff are trained as antibiotic guardians, when we spoke to these patients about their antibiotics we realised that most of them had not been seen face-to-face by the GP for an examination, and they were asking us if we could examine their ears instead. I knew that GPs had stopped doing ear irrigation as well, so we started offering that too.

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

I have done ear irrigation training, and my plan this year is to train in micro suctioning, which is safer, but a more expensive service to set up because of the necessary equipment.

How much did it cost to set up the service?

I had to pay for the irrigation training and purchase an otoscope and disposables, but the service has proved so popular I quickly made back these costs.

In a nutshell, what does the service involve?

If someone has blocked ears it is not always down to ear wax, so I start with an ear exam consultation. Together with the patient I fill in a form where they say in their own words what’s wrong, I check their medical history, and we have a chat about what’s bothering them, how long it has been going on, and so on. Then I’ll examine both their ears even if they tell me the issue is only in one ear, starting with the healthy ear first. I’ll also check for conduction [the transmission of sound vibrations to the eardrum] because if ear wax removal doesn’t ultimately resolve the problem then I know there is conduction issue and I have to refer the patient on.

If there’s nothing wrong with their ears then I send them away, but if they need ear irrigation I’ll book them in to come back in 5-7 days, after they’d had a chance to apply olive oil. I’ll also explain the risks of irrigation and get them to sign a consent form. After irrigation I’ll look after them for two more weeks in case they develop an infection, which is reassurance for the patient that I care for their health and I want to know everything is settling down ok – and all this is included in the original fee.

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

I see three to four patients a week for ear irrigation.

How much do you charge for the service?

The initial consultation fee is £15, which can include me writing a prescription, although the patient will pay for the dispensing. Irrigation is £35 for one ear or £50 for both, and they can come back for the review a couple of weeks later.

Are there any opportunities to sell OTC or prescription products during or after the consultation?

Usually if olive oil is not working to budge the ear wax I up-sell to sodium bicarbonate eardrops. I don’t prescribe unless absolutely necessary, and where I can I try not use antibiotics.

How have patients responded to the service?

I love seeing patients and talking to them, and even though I might not even do anything they’ve been talked to for 20-30 minutes and they go away feeling so much better. Patients have told me they think the service is good value, and because our pharmacy is not in an affluent area I’m trying to be accessible for as many people as possible.

Would you recommend offering this service to other contractors?

Yes – I’d say it is definitely worth it, but my advice is you have to be an IP for it to really work because you need to prescribe the antibiotics or steroid spray as part of the aftercare to make it properly worthwhile for customers. If we keep having to refer patients back to their GP they won’t look to kindly on it, and neither will the doctors.

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