No integrated care boards (ICBs) in England have reported commissioning community pharmacies to provide ear wax removal services, despite two pilots evaluating the success this model, according to data obtained by a charity.

Freedom of Information (FOI) requests submitted by the national hearing loss charity RNID also reveal that six ICBs do not commission ear wax removal services at all, while 13 provide only partial services, with limitations on where it can be accessed or who it can be accessed by.

The charity called for ‘clear national direction’ from government and NHS England, suggesting that the issue could no longer be dealt with by individual ICBs.

No pharmacies delivering NHS ear wax removal

Despite two pilots demonstrating the success of a community-pharmacy-led service, none of the 42 ICBs in England have commissioned such a service through community pharmacies, the FOI data suggested.

The only ICBs that made specific reference to ear wax removal in community pharmacies in their FOI responses were South West London and Mid and South Essex ICBs, which both trialled a pilot service using Tympa Health.

The service improved patient waiting times and accessibility and has empowered pharmacy teams, according to an evaluation of the South West London pilot.

But it was not re-commissioned due to funding constraints, a spokesperson for the NHS South West London ICB told The Pharmacist last April.

Now, one year on, the RNID FOIs reveal that neither the South West London nor Mid and South Essex pilots were re-commissioned.

And other ICBs only made reference to community pharmacy management of ear wax through self-management with drops, the charity noted.

Related Article: Pharmacy ear care pilot sees third of patients within a week

The RNID said advising all patients to self-manage ear wax with drops was ‘incorrect information’, adding: ‘Whilst self-management with ear drops will work for some, there is no evidence that this resolves most cases of symptomatic ear wax.’

‘Strong national directive’ needed on ear wax removal

The charity said that the provision of ear wax removal services in England had ‘collapsed’.

And this was contributing to both health inequalities and rising costs and waiting times in ear, nose and throat (ENT) hospital services.

‘The Department of Health and Social Care and NHS England noted in Reforming Elective Care for patients (January 2025) that people unable to access wax removal services in the community are sometimes referred to hospitals for simple wax removal,’ the RNID said in its latest ‘Stop the Block’ report.

And it said that government and NHS England needed to encourage ICBs to address issues with ear wax removal service provision.

‘Without clear national direction, wax removal service improvement in England is too slow,’ the report said.

It highlighted the example of a national pathway for ear wax management in primary and community care in Wales.

‘In England, RNID believe the issue has now moved far beyond isolated decisions by individual ICBs which the government or NHS England can reasonably ignore.

‘There is a clear need for a strong national directive from the Department of Health and Social Care and NHS England that encourages ICBs to address this problem,’ the charity said.

DHSC admits audiology has been 'neglected'

In response to the RNID's concerns, a Department of Health and Social Care (DHSC) spokesperson told The Pharmacist: 'We are clear that the NHS is broken and community health services like audiology have been neglected.

'A crucial part of our Plan for Change will be moving towards a neighbourhood health service, enabling people to get diagnosed earlier and treated faster, closer to home, and we are committed to slashing waiting times from 18 months to 18 weeks.'

'They haven't thought about ongoing funding'

Amit Patel, chief executive of Community Pharmacy South West London, which took part in one of the pilots, suggested that the trials were not conducted with a long-term plan in mind.

'This happens all the time with pharmacy. We do so many pilots. We prove a case... patients get used to it... and then it gets pulled from us because they haven't thought about ongoing funding,' he told The Pharmacist.

And he suggested that though the government wanted to 'shift care left', resources were not being shifted to primary care to support this.

Related Article: Successful pharmacy ear health pilot will not be recommissioned

Most patients who had received the service during the pilot were now having to pay privately or face long waiting lists, Mr Patel said.

'I spoke to one of my pharmacies about this last week. They had a patient that came in who would have been seen again within a week or two by the pharmacy. They're having to wait 10 months to go to the hospital.

'We've had people like teachers come into pharmacies. [The service] has changed the way they work, because they can hear their class better, they can interact better with the pupils... such a simple thing as ear wax can make such a difference to people,' he said.

The pharmacy pilot delivered a cost saving and a better patient experience in comparison to delivering care through hospitals, Mr Patel said.

Compared to recieving treatment in an acute setting, delivering the care through community pharmacy saved £49.01 per patient, while compared to general practice it saved £2.01 per patient.

And with better utitilisation of community pharmacy capacity, as much as £36.81 per appointment could be saved compared to treatment in a general practice, or £68.16 per appointment compared to treatment in an acute setting, the pilot evaluation report suggested.

Mr Patel told The Pharmacist that more cost comparison with general practice delivery of the service might be useful. But he suggested that 'with access to general practice, and the burden on general practice, pharmacy is probably the right place to have it'.

'We get told a lot that pharmacy doesn't have capacity to take on new services. [But] if you resource pharmacy properly, they can and they will deliver. The capacity is there [but] commissioning is poor,' Mr Patel added.

And he said that while services like Pharmacy First were difficult to plan for, with the ear care service, pharmacies knew how much activity they could expect and could therefore dedicate a number of staff to it.

Delivering a fulfilling service that could make a difference to patients also motivated pharmacy teams, he said.

Related Article: Expanding Pharmacy First to cover earwax removal 'could solve postcode lottery’

Describing the area's winter fit service, which was also short-lived due to funding constraints, Mr Patel said that teams were 'excited about getting up and going to work'.

'The results of that service, from every angle we could possibly look at it, were fantastic. Really high numbers, kept people out of hospital, kept people safe, kept them warm, and it wasn't recommissioned.'

Mr Patel said it was 'too early to tell' what impact changes to NHS England and ICBs would have on local commissioning.

But he said he was hopeful that pharmacy representatives could get involved in local planning and decision-making to advocate for what the sector could provide.