Adding Ear Wax Removal to Your GP Practice: A Step-by-Step Guide

Key Takeaways:

• Ear wax removal was removed from the standard GP contract in 2020, leaving millions of patients without accessible primary care treatment
• GP practices can reintroduce the service via microsuction using trained HCAs or practice nurses, with equipment costs of £3,000-£6,000 and training at £800-£2,000 per clinician
• A mixed commissioning model — NHS enhanced service funding plus private top-up — allows practices to serve all patients while generating sustainable revenue
• Setup costs are typically recoverable within 3-6 months, with ongoing margins of 65-80% per appointment

Why GP Practices Stopped Offering Ear Care

Until 2020, ear wax removal was a routine part of general practice. Practice nurses and healthcare assistants performed ear irrigation (syringing) as a standard service, and patients could access treatment within days of contacting their surgery.

Two developments changed this:

1. NICE guidance update — Updated recommendations moved away from ear irrigation as a first-line treatment, citing perforation risk and patient discomfort, and endorsed microsuction and manual removal as safer alternatives
2. GP contract changes — Ear wax removal was removed from the list of services GP practices were required to provide, and the associated funding was withdrawn

The result was a rapid withdrawal of ear care from primary care. Most practices stopped offering the service entirely, citing the cost of new equipment, training requirements, and the absence of contractual obligation.

The Impact on Patients and Practices

The consequences have been significant. Patients with impacted ear wax — a condition affecting approximately 1 in 15 adults — now face a fragmented pathway:

• NHS waiting times of 4-12 weeks where community services exist
• No NHS provision in many areas, forcing patients to seek private treatment at £50-80 per ear
• Increased ENT referrals from GPs who cannot resolve the problem in-house, adding pressure to already overstretched secondary care
• Patient dissatisfaction directed at GP practices, affecting satisfaction surveys and complaints data

For practices, the gap also represents a missed opportunity. Ear wax removal is a high-volume, low-complexity procedure that builds patient loyalty and generates revenue — precisely the type of service that primary care is best placed to deliver.

Commissioning Models for GP Ear Care

NHS Enhanced Service

Some Integrated Care Boards (ICBs) commission ear wax removal as a locally enhanced service, paying practices a per-procedure tariff (typically £30-£50 per appointment). This route provides NHS-funded access for patients and a predictable revenue stream for practices.

To access enhanced service funding, practices typically need to demonstrate:

• Appropriately trained staff with accredited qualifications
• Suitable equipment meeting current clinical guidance
• Documented clinical governance including consent, infection control, and audit

Private Top-Up Model

Where enhanced service funding is not available — or where demand exceeds commissioned capacity — practices can offer ear wax removal as a private service. This is increasingly common and well-accepted by patients who understand the service is no longer part of the standard GP contract.

Typical private charges are £50-£60 per ear or £70-£80 for both ears, consistent with the wider private market.

Mixed Model

The most sustainable approach combines both: NHS-funded appointments for patients meeting specific criteria (e.g. hearing aid users, patients with hearing loss affecting communication) and private appointments for routine ear wax removal. This ensures equitable access while maintaining financial viability.

Staff Training

Microsuction is not a procedure that existing staff can simply add to their repertoire without formal training. The following roles are most commonly trained:

Healthcare Assistants (HCAs)

HCAs who previously performed ear irrigation are well-placed to transition to microsuction. They are familiar with ear anatomy, patient communication, and the clinical workflow. A structured training course of 1-2 days with supervised clinical practice is typically sufficient.

Practice Nurses

Practice nurses bring a broader clinical assessment capability, allowing them to identify contraindications, manage complications, and make onward referral decisions. Many training providers offer nurse-specific microsuction courses.

Training Costs and Requirements

• Course fee: £800-£2,000 per clinician depending on duration and clinical placement
• Supervised practice: Most training standards recommend 20-50 supervised procedures before independent practice
• Ongoing CPD: Annual updates and audit of outcomes

Training two staff members provides resilience for leave cover and session flexibility.

Equipment Requirements

A GP practice setting up for microsuction needs:

Equipment selection matters. The choosing microsuction equipment guide covers the key factors in detail. Noise output deserves particular attention in a GP setting, where thin walls and adjacent consulting rooms mean patients and staff in neighbouring rooms can hear the procedure.

Room Requirements

Microsuction does not require a dedicated treatment room, but the room used should meet basic standards:

• Adequate lighting — Natural light supplemented by an adjustable clinical light
• Comfortable patient seating — An adjustable chair or couch allowing the clinician to access the ear at the correct angle
• Ventilation — Standard clinical room ventilation is sufficient
• Infection control provisions — Handwashing facilities, clinical waste bin, sharps container
• Power supply — Accessible mains socket for the microsuction device
• Noise consideration — Select a room that minimises sound transmission to adjacent consulting areas; quieter devices like the Zephyr significantly reduce this concern

Most GP practices have at least one treatment room that meets these requirements without modification.

Appointment Scheduling

Appointment Length

Allow 15-20 minutes per appointment. This provides time for:

• History and consent (2-3 minutes)
• Otoscopic examination (1-2 minutes)
• Microsuction procedure (5-10 minutes)
• Post-procedure check and advice (2-3 minutes)
• Documentation (1-2 minutes)

Session Structure

A half-day ear care session (3.5 hours) can accommodate 10-12 appointments. Running one or two sessions per week is a common starting point, scaling up as demand builds.

Coding and Billing

For NHS-funded appointments, use the appropriate SNOMED codes for ear wax removal and microsuction. For private appointments, a clear invoicing process separate from NHS systems is essential. Practice management software typically supports both pathways.

Clinical Governance and Audit

Establishing a robust governance framework is essential, particularly if the practice is already CQC-registered:

• Standard operating procedure — Documenting the microsuction pathway from referral to discharge
• Consent process — Written consent covering risks including tinnitus, dizziness, and perforation
• Infection control protocol — Decontamination standards for any reusable equipment
• Outcome audit — Recording procedure outcomes, complications, and patient-reported experience at regular intervals
• Referral criteria — Clear pathways for patients who need ENT referral (e.g. failed removal, suspected cholesteatoma, unexplained hearing loss)

Financial Summary

For a GP practice running two half-day sessions per week:

• Weekly capacity: 20-24 appointments
• Average revenue per appointment: £55 (blended NHS/private)
• Weekly revenue: £1,100-£1,320
• Monthly revenue: £4,400-£5,280
• Monthly variable costs: Consumables £200, staff time (existing salaried staff) £0 marginal
• Monthly contribution: £4,200-£5,080
• Startup cost recovery: 1-3 months

Even accounting for a slower ramp-up period, most practices recover their investment within 3-6 months. The service then generates a reliable, high-margin revenue stream while simultaneously improving patient access and reducing costly ENT referrals.

Getting Started

1. Assess demand — Review the number of ear wax-related consultations and ENT referrals your practice currently generates
2. Check commissioning — Contact your ICB to determine whether enhanced service funding is available
3. Identify and train staff — Select one or two clinicians and enrol them in an accredited training course
4. Procure equipment — Select a device based on clinical performance, not just price
5. Establish governance — Develop SOPs, consent forms, and audit templates
6. Communicate with patients — Publicise the new service through your practice website, reception, and patient communications
7. Launch and iterate — Start with one session per week, gather data, and scale based on demand