GPwSI / GPwER ENT in Liverpool

As part of our ENT pathway, you will assess and manage patients with a broad range of routine ENT presentations, delivering specialist consultations and office-based procedures within a community setting. You will play a key role in supporting efficient patient pathways through expert clinical decision‑making, treatment planning and onward referral where appropriate.

Conditions and Patients Within the Service

• Adults and paediatric patients within the locally commissioned age range presenting with routine, stable ENT conditions suitable for community-based assessment and management.
• Patients requiring Tier 2 ENT assessment where appropriate primary‑care treatment has failed, diagnostic uncertainty remains, symptoms persist, or specialist ENT assessment and clinical decision‑making is required.
• Common uncomplicated ear conditions, including recurrent or chronic otitis externa, cerumen impaction requiring microsuction, Eustachian tube dysfunction, glue ear within the agreed adult scope, and simple dry tympanic membrane perforation.
• Non‑sudden hearing loss requiring clinical assessment, basic audiology, reassurance, advice or onward referral to an appropriate hearing‑aid pathway.
• Non‑pulsatile tinnitus without neurological, unilateral or other red-flag features.
• Peripheral vertigo or dizziness consistent with a benign cause and suitable for management or onward referral through an agreed community vestibular pathway, where commissioned.
• Chronic rhinitis, uncomplicated chronic rhinosinusitis, nasal obstruction, uncomplicated nasal polyps and deviated nasal septum requiring community ENT assessment.
• Recurrent minor or non‑complex epistaxis suitable for outpatient assessment and simple nasal cautery.
• Globus, throat discomfort, recurrent tonsillitis, benign tonsillar disease and low‑risk dysphonia/hoarseness following appropriate triage and suitable for community ENT assessment.
• Benign‑appearing ear or nasal lesions suitable for diagnosis, reassurance or an agreed minor‑procedure pathway.
• Patients requiring diagnostic procedures available within the commissioned service, which may include otoscopy/otomicroscopy, basic audiology, tympanometry, nasendoscopy, microsuction and simple nasal cautery.
• Patients suitable for management within a community ENT setting where there is no requirement for emergency intervention, complex imaging, general anaesthesia, inpatient care or tertiary ENT assessment.

Exclusions and Onward Referral

• The GPwSI / GPwER ENT will ensure that patients whose clinical needs fall outside the commissioned community ENT service are appropriately referred to the relevant urgent, hospital, tertiary or multidisciplinary pathway.
• The following presentations are outside the scope of the service:
• Suspected head and neck cancer or other urgent suspected‑cancer presentations, including neck lumps, persistent unexplained unilateral symptoms, unexplained weight loss, haemoptysis, significant dysphagia/odynophagia or persistent hoarseness meeting urgent referral criteria.
• Acute or emergency presentations, including airway compromise, stridor, severe dysphagia, significant haemorrhage or uncontrolled epistaxis, mastoiditis, severe infection, sepsis or other conditions requiring emergency assessment.
• Sudden sensorineural hearing loss, acute facial nerve palsy, neurological deficit, central vertigo or other acute neurological or neuro‑otological presentations requiring urgent specialist assessment.
• Pulsatile tinnitus or concerning unilateral tinnitus requiring urgent investigation or specialist imaging.
• Non‑healing oral ulcers or lesions requiring dental, oral and maxillofacial or suspected‑cancer assessment, including primary dental conditions.
• Acute nasal fracture or significant facial trauma.
• Suspected obstructive sleep apnoea unless an agreed community sleep pathway forms part of the commissioned service.
• Complex airway, voice or swallowing disorders, aspiration risk or conditions requiring specialist speech and language therapy, hospital‑based MDT assessment or tertiary input.
• Patients with an obvious requirement for surgery, general anaesthesia, inpatient or overnight care, complex imaging or specialist tertiary ENT management.
• Cochlear implant assessment, skull‑base disease, complex otology and other tertiary ENT subspecialty conditions.
• Procedures or treatments falling outside the agreed GPwSI / GPwER ENT scope, commissioned service, facility, equipment or available clinical workforce.
• Patients outside the locally commissioned age or geographical criteria, referrals that cannot be safely triaged because of incomplete clinical information, or treatment requiring unapproved individual funding.