Service Support Nuggets

25/6/2025 – Responding to Earache in Adults (minimising referral backs)  – NHS Pharmacy First

1. a) Earache can be electronically referred as a Pharmacy First ‘Minor Ailment,’ from age 1 upwards.
2. b) Where appropriate a pharmacist can escalate a Pharmacy First ‘Minor Ailment’ referral to the status of a Clinical Condition
3. c) The PGD permits the lawful supply of an antibiotic to treat acute otitis media (AOM) in patients aged 1-17 years old.

d Adult earache is less likely to be caused by infection, but it nevertheless still merits an intervention fee, even IF the selected outcome at the end is a referral back.

1. e) Thus pharmacists should ideally examine the ears of electronically referred [but they are not obliged to examine verbally signposted patients]

[ The PCN/GP toolkit at 5.3.1 specifies e. Referrals as a requirement for pharmacy referrals]

1. f) If an adult patient with earache does not have signs of infection, the pharmacist may recommend treatment options such as OTC analgesia, ear wax softener, etc
2. g) Where an adult with earache does have signs of infection or ear-drum perforation, or any red-flag symptoms, the pharmacist will electronically refer them back to the surgery, recommending a routine GP appointment.
3. h) The pharmacist should use the referral-back message to explain why the patient is being referred back, including any clinical observations, concerns, or suspected red-flag matters.
4. i) If the adult with earache has Acute Otitis Media, the referral back might include a prescribing suggestion where the pharmacist is confident in the circumstances.

The practice would then have the options of prescribing the suggested item, or requesting the patient to come in, for a GP to have another look.

Summary:  ALL electronically referred earache patients qualify for a Pharmacy First intervention, as a minor ailment, or as a clinical condition. 

The patient should have an otoscopic examination, and the pharmacy can claim a service intervention fee, even if in the end the patient is referred back.