Patient Initiated Follow Up: Giving patients greater control over their hospital follow-up care

Following a hospital appointment it is often necessary to arrange follow-up appointments for ongoing care. Traditionally, these appointments are offered at routine intervals but in some cases, patients might need a follow-up appointment sooner than their scheduled session or they may agree with their clinician that a follow-up is not required unless their symptoms flare up or their circumstances change.

To give patients and their carers the flexibility to arrange their follow-up appointments as and when they need them, NHS England and NHS Improvement is supporting providers to roll out patient initiated follow-up (PIFU).

PIFU can be used with patients with long or short-term conditions and following treatment or surgery. Its use can be effective in a broad range of specialties including dermatology, rheumatology and cancer. Adopting this approach makes it easier and more convenient for patients to receive care and support when they need it, whilst avoiding unnecessary trips to hospitals and clinics, saving them time, money and stress.

The approach helps empower patients to manage their own condition and plays a key role in enabling shared decision making and supported self-management in line with the personalised care agenda.

For clinicians, it means more time to spend with the patients who most need their support whilst feeling assured that they are there for all of their patients when they are needed most.

Patient quote: “I understood…that he [my doctor] wouldn’t think, ‘oh, she is just having a bit of a whinge’ – she is contacting me because she needs me, because there is something not working.”

Delivering PIFU is part of the outpatients transformation requirements laid out in the 2021/22 Operational Planning Guidance and is a key part of the NHS’ response to the COVID-19 pandemic, helping providers and systems manage waiting lists and to see patients most in need more quickly.

Consideration must be given to safety, effectiveness and patient preference when placing patients on a PIFU pathway. Criteria for setting out which patients are right for PIFU is provided in the phase 3 implementation document. Providers should also consider how they track patients on a PIFU pathway and the safety nets they need to put in place to ensure they continue to deliver safe, high quality care to all of their patients.

PIFU is not a new concept, and commonly goes by a number of other names including open access follow-up, patient led follow-up, patient triggered follow-up, patient initiated appointments, supported self-managed follow-up, self-managed follow-up, see on symptom, open appointments, open self-referral appointments or patient-activated care.

Personalised follow-up

Personalised follow-up describes when a patient’s follow-up care is tailored to their individual clinical need, circumstances and preferences. Personalised follow-up is sometimes called personalised stratified follow-up (as in cancer pathways).

PIFU is one model of personalised follow-up, other recognised models include:

  • Remote monitoring, when the clinical team initiate an appointment based on clinical information obtained through monitoring the patient’s condition. This might be through using wearable technologies, apps, clinical questionnaires or from test results
  • Timed follow-up, when a patient’s next appointment is planned during an appointment, with the length of time between appointments based on the individual patient’s needs rather than set intervals.

To personalise follow-up appointments to the patient, these models can be used on their own, or in combination depending on the individual needs of the patient.

For queries and further information on implementing PIFU, please see the Implementing phase 3 of the NHS response to the COVID-19 pandemic guidance. We have developed a range of support materials including materials to support implementation of PIFU in key specialty areas. For more information on the national and local support on offer to help you implement PIFU, please email  nhsi.outpatient-transformation@nhs.net or visit our FutureNHS workspace.

For patients looking for more information about outpatient care, please visit the Outpatient and day patients on the nhs.uk website.