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

For people with long term conditions, or following surgery, it is often necessary to arrange follow-up appointments to return to hospital or clinic and provide ongoing care.  In some cases, patients might need to return for a follow-up appointment sooner than their scheduled session. In others, patients and their clinicians may agree that an automatic follow-up is not required.

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

This might be when they have a flare up of their symptoms or change in their circumstances, rather than having their appointments at routine intervals as is traditionally offered. This helps avoid unnecessary routine appointments and makes it easier for patients to book appointments when they really need them.

The PIFU approach helps to empower patients to manage their own condition and to take responsibility for arranging the appointments they need, and plays a key role in enabling shared decision making and self-management in line with the personalised care agenda.

As well as improving patients’ access and experience of care, adopting a PIFU approach helps to reduce service waiting lists by reducing demand for follow up appointments. Used alongside clinical waiting list reviews, remote consultations and a ‘digital first’ approach, PIFU will be an important tool for providers’ during the COVID-19 recovery.

PIFU is one aspect of personalised follow up which describes the broader concept of 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 or person-centred follow-up.

Other recognised models of personalised follow up are:

  • Clinically triggered follow up, when the clinical team initiate an appointment when required. Triggering an appointment is based on clinical information obtained through monitoring the patient’s condition (e.g. using wearables, apps or 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.

These models can be used either on their own, or in combination depending on the individual needs of the patient.

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.

For queries and further information on implementing PIFU, please see the Implementing phase 3 of the NHS response to the COVID-19 pandemic guidance and/or email nhsi.outpatient-transformation@nhs.net

For additional information on implementation in cancer, please see guidance published by the national cancer programme.