Elective care reform plan unveiled: CCA backs expansion of pharmacy-based ENT services

CCA supports a Pharmacy-First style approach to ENT services, but highlights the urgent need for increased funding in the sector

The Labour government published its elective care reform plan today (6 January), outlining the necessary steps to reduce patient waiting times, including expanding non-surgical ENT [ear, nose and throat] services in community pharmacies.

As set out in its ‘Plan for Change’, the government aims to restore the constitutional standard of 92 per cent of patients receiving treatment within 18 weeks by March 2029. Additionally, it plans to address the ongoing challenges in meeting cancer waiting time standards.

Health secretary Wes Streeting emphasised the urgency of reform, highlighting that over 6 million people are currently on a waiting list, waiting for more than 7 million episodes of care, like a test or an operation.

Streeting said: “For those millions of people, the fundamental promise of our NHS – that it will be there for us when we need it – has not been delivered. This can’t go on.”

“The actions in this plan will reform elective care, giving patients timely local access to diagnostic testing, with straight to test pathways and action to reform outpatient care, including reducing unnecessary follow up appointments, freeing up clinical time for those who need it.”

“We will set the funding and design incentives to make that happen and will expect and oversee improvement from all trusts, not just those languishing at the bottom of a table,” he added.

This plan will lay the groundwork for three big shifts outlined in the 10 Year Health Plan - from hospital to community, from analogue to digital, and from sickness to prevention - to make NHS fit for the future.

NHS chief executive Amanda Pritchard acknowledged that, while the NHS has made significant progress in reducing long waiting times, too many patients are still waiting too long for care.

“By the end of 2024, around one in nine people in England were waiting for elective care – around 1 million more than in February 2022 – and the total waiting list has grown by over 1.3 million pathways.

“And while the proportion of those waiting for more than a year has decreased by almost half, the proportion waiting for longer than the 18-week constitutional standard is still too high.”

NHS data shows that, as of October 2024, the total waiting list stood at 7.5 million pathways, with 6.3 million patients waiting for an appointment, procedure, or operation. More than two-fifths of these patients were waiting for over 18 weeks.

The 62- and 31-day cancer waiting time standards have not been met since 2014/15 and 2019/20 respectively.

Pritchard emphasised that these reforms are focused on “improving how people access and experience routine care, as much as they are about waiting times.”

Key commitments in the reform plan:

• Meeting the 18-week standard by March 2029
• Reducing the percentage of patients waiting less than 18 weeks for elective treatment to 65 per cent nationally by March 2026 (currently, it stands at 96 per cent)
• Ensuring every NHS trust achieves a minimum 5 percentage point improvement by March 2026.

To meet the 18-week standard and reform elective care, the government will be focusing on empowering patients, reforming delivery, delivering care in the right place, and aligning funding, performance oversight and delivery standards.

Community-based ENT services to be expanded

The elective care reform plan also includes addressing waiting list challenges in high-demand specialties such as ENT, gastroenterology, respiratory, urology, and cardiology.

“ENT is currently mainly delivered in secondary care, including tinnitus and simple ear infections, although approximately 30 per cent of referrals can be managed earlier and in a more convenient setting,” the Plan stated.

It proposes expanding non-surgical community-based ENT services, maximising promoting Pharmacy-First approaches, and developing one-stop clinical models to support patients needing ear care and patients with rhinitis.

Company Chemists’ Association (CCA) has welcomed the government proposal for a Pharmacy-First style approach to ENT services.

"Pharmacy First has proven to be a success in a short space of time, and expansion into new conditions will ensure even more patients benefit," said CCA chief executive Malcolm Harrison.

"If the Government and NHS England are serious about shifting care into the community, as well as freeing up GP capacity, they should consider how they can help turbocharge Pharmacy First."

Harrison also emphasised that solving the NHS' strains will only be possible if people can access “the right care, in the best place, as soon as possible.”

He stressed the importance of increasing pharmacy funding to improve patient access to essential care.

“A greater proportion of funding must go into primary care if patients are to access the care, they need from the NHS.

“Pharmacies are well placed to diagnose and prevent ill health, with most people in England living within a 20-minute walk of their local pharmacy.

“However, having experienced a 40 per cent real-terms cut in funding since 2015, and 1,200+ closures since 2017, pharmacies urgently need an uplift in funding so they can continue to provide the ‘walk-in’, extended hours, access that people need and expect."

Hearing health pilot in South West London

The NHS England highlighted a successful case study from South West London, where the Integrated Care Board (ICB) launched a 12-month hearing health pilot across 20 community pharmacies. Trained pharmacy staff conducted digital otoscopy, earwax removal, and hearing checks using a mobile-based three-in-one otoscopy device.

During the pilot, 7,648 patients were referred by 72 GP practices to the participating pharmacies. Of these, 36 per cent were seen within one week, and 87 per cent within four weeks. Nearly 70 per cent of patients completed their treatment within the community pharmacy setting, with only three per cent requiring referral to secondary care, such as ENT or audiology services.

Patient feedback was incredibly positive, with 99 per cent expressing satisfaction with the service and 98 per cent stating they would recommend it to family and friends.

Starting in January 2025, NHS England will establish a Task and Finish Group, which will work in partnership with clinical and operational staff to define clear expectations for administrative practice  and operational management in the delivery of elective care by September 2025.