By Dr Jo Garland

What is PIFU?

Patient Initiated Follow-Up, known as PIFU, is a way to give patients more control over their interactions with hospital outpatient teams. Instead of routine follow-up appointments being automatically booked, patients can decide if they would like an appointment and request it themselves at a convenient date and time.

PIFU is not a new concept in the NHS and is already prevalent in some regions, but NHS England is now supporting the roll-out of digitally-enabled PIFU, which will standardise PIFU and enable all NHS organisations to benefit.

The ambition is that a national PIFU scheme will help reduce unnecessary appointments, freeing up clinical time to help get on top of the backlog more quickly.

PIFU benefits for patients

PIFU has significant benefits for patients, empowering and supporting them to manage their symptoms and condition and make decisions about their care.

For patients with long-term conditions, it makes sense to be able to initiate a consultation when symptoms flare up or if they have a concern or query. They can also be given care and support while they are at home.

PIFU is flexible and suits a diverse clinical population; patients can be stratified according to risk and have individual follow-up pathways. The method of follow-up is personalised, ranging from a virtual consultation or call to assessment forms, while appropriate information can be sent in a range of formats including in writing or video. This helps prevent avoidable appointments and the associated difficulties of travel, taking time off work or needing a carer to accompany them.

PIFU also enables earlier review of patients by freeing up automatically booked appointment times that may not be necessary under PIFU.

PIFU benefits for the NHS

One of the key benefits of digital PIFU for the NHS is that clinical staff can monitor patients and communicate with them, without needing an in-person appointment. This relinquishes appointments for those that really need them.

With long waits for outpatient appointments, using PIFU effectively can help the NHS save significant clinical time and reduce waiting lists.

PIFU is part of the outpatients transformation strategy in the 2022/23 Operational Planning Guidance and is part of the NHS’ response to the COVID-19 pandemic - so it’s essential trusts get this right. They have been given the target of reducing outpatient follow-ups by a minimum of 25% by March 2023, and to move or discharge 5% of outpatient attendances to PIFU.

The clinical risks of digital PIFU

As a clinician, I know there are huge potential benefits of PIFU, but there are also clinical risks which must be mitigated.

The key risk is that patients that do not request a follow-up when they need to. Most clinicians will have concerns that non-engagement might delay detection of recurrence or diagnosis of co-morbidities and could lead to avoidable harm. This is where digital systems can definitely help.

Patients are unable to initiate follow-up

Patients may be unable to initiate follow-up because of a lack of confidence, language barrier or other incapability.Physical issues may be a factor preventing them from using technology, and of course not all patients have access to the internet or devices.

It is vital that hospitals give clear explanations of the changes to both patients and staff and provide alternatives for patients that cannot use digital systems despite training and help.

For patients suitable for PIFU and willing to engage digitally, hospitals must assess whether they can use the technology and access the system.

Patients choose not to initiate follow-up

Giving patients a list of symptoms and signs when they should get in touch has the potential to raise fear without empowering the patient to reach out and leaving them feeling a burden of responsibility.

Patients may also avoid contacting clinicians or even ignore symptoms because they are scared about what it might mean. Or they may be hesitant to approach clinicians with issues they aren’t sure about. Without a regular in-person appointment, these issues may fall through the gaps.

To mitigate this risk, clinicians must ensure that patients have sufficient information and knowledge to know what symptoms or signs should trigger action, helping them to make the right judgement call.

They can also use digital tools like Infinity to easily identify patients who have not been in touch for a specified length of time. Clinicians can then take action to manage any associated risks - for example by calling the patient to verify why they haven't made contact.

Not all patients are suitable for PIFU

Certain patients may be less suited to PIFU. Not only do some patients require active monitoring - for example through devices - but there are wide variations in patients being able to take responsibility for their health needs.

Digital care coordination solutions like Infinity can integrate with remote monitoring devices in PIFU pathways. Clinical teams can see and review monitoring data, and initiate follow-up if they feel it is needed.

Digital PIFU is essential to reduce the backlog

Any PIFU process - digital or otherwise - needs to be easy, efficient and clear, so patients understand how to engage and do not feel anxious about doing so and feel their concerns are legitimate. Hospital communications will play in key role in informing patients about their options and how to engage.

I believe that digitising PIFU and rolling it out nationally will help create clinical bandwidth to see the patients that really need it, when they need it. Crucially the clinical risks can be mitigated with a digital tool like Infinity.

Infinity is part of a nationally sponsored pilot scheme working with two NHS trusts to digitise their PIFU processes and help reduce their waiting lists. If you would like more information or to work with us, please get in touch.

About the author

Dr Jo Garland worked as a General Practitioner in North West London for several years, before making the move into NHS training and facilitation and then healthtech.

Jo believes that staff need the right tools to manage their everyday workload, and focuses on how technology can reduce the administrative burden and allow more time to care. She is passionate about joining-up care between primary, secondary, and community care within the NHS.

At Infinity, Jo’s primary goal is to work with healthcare professionals to understand their current efficiency challenges, and support the roll-out of our digital solution to solve them.

Prior to joining Infinity, Jo led health coaching programmes for patients with long-term conditions, working to reduce inappropriate A&E admissions. She also previously worked on the nationally-funded NHS Right Care Shared Decision-Making Programme, facilitating the production of patient decision aids.