South West London ICB shares findings and recommendations from digital otoscopy pilot

Findings from a pilot project involving utilisation of a device to perform digital otoscopy have been published by South West London (SWL) ICB, with the report highlighting positive staff and patient responses; nearly 90 percent of patients being seen in less than four weeks; and cost savings of over £250,000 over the pilot’s 12 months.

To address “a lack of equitable and free NHS hearing health services” in SWL, the ICB developed the ‘Hearing Health Pathway Pilot’ to be delivered across 21 community pharmacy sites; it involved pharmacy staff utilising a three-in-one otoscopy device to perform digital otoscopy, earwax removal and hearing checks.

On key outcomes, the report highlights that a total of 7,648 patients were referred to the pathway, with 87 percent of these being seen “in less than four weeks”; 70 percent completing treatment in community pharmacies; and three percent of appointments resulting in a recommendation for referral into secondary care.

Findings across acceptability and usability included that “patient experience of the service was very positive”, with 98 percent of patients stating that they would recommend the service to family and friends; and that staff “generally found both the pathway and technology (device and IT systems) straightforward to use, without disrupting established workflows”.

On safety and sustainability, the report found that the triage process, quality reporting process and feedback loops appear to have “worked well” or been effective, and initial analysis “suggests the pilot may have seen a positive impact in providing care closer to home and reducing travel times for patients and associated CO2 emissions”.

The report concludes that “community pharmacy appeared to have suitable capacity to deliver the service” as long as staff received sufficient training, with the pilot generating net savings per patient of £49.01, or a total of £262,079 over the course of the 12-month period. With scenario modelling assuming a best-case scenario of 85 percent utilisation across pharmacy sites, a unit cost saving of £36.81 per appointment is estimated compared to treatment in general practice, or a unit cost saving of £68.16 per appointment compared to treatment in an acute setting of care.

Recommendations for SWL ICB include gathering and monitoring data to measure performance against the pilot’s aims of reducing inequality; ensuring ongoing training; improving clarity in the referral process; continuing to monitor the workforce model; and considering how interoperability between systems can be improved “to support local stakeholders not using the pilots IT systems to participate in future”.

The report also offers three recommendations for NHS England, including recognising the importance of local knowledge in planning for implementation; producing commissioning guidance “to support and enable future hearing health pathway pilots”; and working with national stakeholders to “ensure that national governance processes support the successful implementation and delivery of these services at a local level”.

Finally, for ICSs and at-scale commissioning, the report highlights key considerations across culture and relationships, design of a local model, safety, contracting, setting up of a pilot, and implementation. On information and data, it recommends establishing expectations of clinical information sharing and processes, such as technology preferences at the outset, as well as considering interoperability needs for local IT and automation of information flow between pharmacy and general practice, and considering “mechanisms for enabling visibility of waiting times or appointment slots”, such as self-booking or general practice triage.

To read the report in full, please click here.

In other news from South West London, the ICB recently shared insight into how a digital system is being used at a practice in Kingston to triage patients.