In order to tackle the backlog in cases that have built up during the pandemic, we need to radically rethink and redesign the way that elective care services, including outpatient services, are organised and delivered with a focus on best possible outcomes and experience for patients.
One of the key elements in ‘The delivery plan for tackling the COVID-19 backlog of elective care’ is about going further and faster in rolling out a personalised approach to follow-up care. Patient initiated follow-up (PIFU) describes when a patient, or carer, can initiate follow-up appointments when they need one, rather than having a series of follow-up appointments set by a clinician. This can be when they experience a change in symptoms or circumstances. The PIFU pathway helps patients be seen quickly when they need to, while avoiding the inconvenience of appointments they don’t need; and aims to free up the time of clinical teams to focus on patient who need more help.
In the North West we have been working across multiple specialties with clinical and operational teams to ensure we develop pathways with shared decision making and personalised care at the heart of PIFU. In May 2022 there were 12,800 patients across the region who had been moved or discharged to a PIFU pathway, 3,000 more than the previous month. We estimate this could save 14,000 potentially unnecessary face to face follow up appointments.
At the moment, trauma and orthopaedic and physiotherapy services are using PIFU for their patients the most in the region. Opportunities are now being explored in other specialties with high volumes of follow-up appointments every year; for example colleagues in Lancashire and South Cumbria are looking at ophthalmology appointments, which could further help to reduce the pressure on the NHS where we have patients waiting the longest.
As part of the NHS England Gastro Adoption fund, the gastroenterology team at Liverpool University Hospitals have recently begun a pilot to assess the benefits of providing the opportunity following clinical assessment for patients to complete a faecal calprotectin test in the convenience of their own home, as well as developing a supporting PIFU pathway. The expected outcomes of this project are to improve patient experience, provide more responsive clinical care and reduce unnecessary outpatient attendances.
Although still in its early stages, results so far have been encouraging with PIFU rates well above initial expectations and take up from a small number of FCP At Home test kits showing good initial engagement from patients along with some great outputs to support clinical interventions.