Published by West Cornwall HealthWatch 

12th June 2022 

Discussions in Cornwall about earwax removal continue, sadly with no end in sight.  NHS Kernow has decided to defer a decision, but to “incorporate any decision into a wider review of locally commissioned enhanced services”, while doing “further work to develop a proposal for a pathway enhanced service scheme”.    In layman’s terms, earwax removal will be considered along with other services when deciding which services will be provided on the NHS and which will not, based on competing demands for funding.  It is not clear when a final decision will be made.

The review, initiated in October 2021 following many concerns and complaints being raised by members of the public, local organisations and MPs, as well as the Health and Adult Social Care Overview and Scrutiny Committee at Cornwall Council, has clearly ”identified an emerging gap in the provision of ear irrigation services for the removal of troublesome ear wax. There is currently an inconsistency of provision in primary care as a declining number of GP practices are providing an ear irrigation services.”  Furthermore “Best practice guidance recommends an ear wax removal service in primary care for patients where there is a clinical need. Neighbouring clinical commissioning groups (CCGs), including Devon, commission a service in line with this guidance. The absence of a commissioned service in Cornwall and Isles of Scilly is leading to inequalities of access and health and wellbeing problems for those who suffer with ear wax blockage or impaction.”

The review continues: “Patients who are requesting treatment for troublesome ear wax are being signposted to self-care guidance and increasingly micro suction services provided by the private sector.” Since earwax removal is not currently commissioned by NHS Kernow and so GP practices are not required to provide the service, there are some practices, including at least one in Penwith, which have chosen to provide it, understanding the value of this to their patients.  Most however, have not – causing patients anxiety and confusion, and necessitating accessing private treatment, often a long way from home and at considerable cost, for those who can afford it, and leaving the others with no treatment at all.  Furthermore, the numbers of people who are affected are considerable – the review has identified an estimated 23,845 people across Cornwall (some 3.75% of the entire registered population.)  

West Cornwall HealthWatch is disappointed and frustrated at the further delay, particularly since the review findings were clear – this is a service which should be provided in our local doctors’ surgeries – but there is reluctance to commit because it will cost money (the review has calculated that ear irrigation in general practice costs £17 per patient, and microsuction £55.  We can only repeat the same assertion we have made for nearly two years, that providing this as an NHS funded service (as has been the case since the start of the NHS) is the correct path to follow. Meanwhile, private companies (unregulated and with no link to general practice) have been springing up to fill the gap, but this is so evidently inequitable that it cannot continue. 

Of the five options identified by NHS Kernow in their review, we call on those making the decision to select Option 4: “Complete ear wax removal service in primary care. Commission electronic ear irrigation in general practice through an enhanced service scheme. Commission micro suction in general practice through an enhanced service scheme (at Primary Care Network or Integrated Care Area level).”         Nothing less will adequately meet the needs of our population.