The purpose of PIFU

There’s been a change in perspective regarding the necessity for follow-up appointments. Healthcare teams used to provide regular follow-up appointments to prevent patients’ conditions from getting worse. However, the purpose of PIFU is to reduce the number of unnecessary appointments, allowing patients to arrange their own follow-ups to meet their needs.

There’s a mutual benefit here: patients are provided autonomy, while healthcare teams are afforded time — the latter being the NHS’s golden ticket to save money and placate its perennial pressure.

PIFU for patients

PIFU’s sustainability can be measured by its tangible benefits to patients — unnecessary appointments result in unnecessary costs, including travel and parking fees. Requesting undue time off work can also deal a blow to patients’ finances. Taking into account the increased anxiety that comes with hospital visits, practising PIFU seems to be the common sense course.

PIFU generates a sense of “control” for patients — a positive side effect in an ever-scrutinised and personal industry.

Patients, particularly those with a more pragmatic perspective, can gain a sense of mental and emotional relief from not having to attend an appointment that they deem unnecessary or too early. Conversely, seeing a healthcare professional sooner may be necessary rather than waiting for a pre-arranged appointment at a seemingly too-late date.

It’s worth noting that PIFU is not a universal inevitability. The patient must feel empowered enough in order for PIFU to be effective. Fortunately, healthcare teams will involve the patient when it comes to deciding on its suitability.

Implementing PIFU

After patients discuss PIFU with their healthcare team, they will be given the following details regarding the service:

• What is PIFU
• How to get in contact with their team
• The duration of PIFU
• How to access an appointment

Booking a PIFU appointment is quick and easy — another important factor in this patient-centric initiative. Patients can use the contact details on their leaflet or letter to arrange their appointment.

The conception of PIFU

Although it is a seemingly precocious aspect of healthcare, PIFU, as a concept, is not new.

It commonly goes by various names, such as:

• Access follow-up
• Patient led follow-up
• Patient triggered follow-up
• Patient initiated appointments
• Supported self-managed follow-up
• See on symptom
• Open appointments
• Open self-referral appointments
• Patient-activated care

PIFU and pandemics

PIFU is a conspicuous protagonist of the outpatients transformation requirements as outlined in the 2022/23 “Operational Planning Guidance”. It is an integral part of the NHS’ response to the COVID-19 pandemic, helping providers and systems to manage waiting lists and see patients most in need more quickly.

The fundamental function of PIFU, and its incidental importance in relation to a health pandemic, as an example, is pertinently put forward in the foreword of the guidance document “Implementing patient initiated follow-up: Guidance for local health and care systems” (version 1, May 2022):

“NHS outpatient services deliver essential care for patients. However, we all know of occasions when patients attend routine appointments that they do not need because they are well and their circumstances have not changed. Outpatient services need transforming to better suit modern lives – with patients having access to a specialist when they need this, rather than according to a routine schedule – as well as to tackle the challenges we face in healthcare delivery. The COVID-19 pandemic brought this into stark contrast. We witnessed a step change in how outpatient care is delivered: clinicians, staff and services quickly adapted to new approaches that will improve patient experience of outpatient services now and in the future.”

The foreword reiterates that PIFU is one of these positive changes. Its aim is, after all, to empower patients to take control of their care, making sure that they can be seen by a specialist sooner and when it is most necessary. Not to mention, and re-stress, PIFU assists clinicians in managing their waiting lists securely and efficiently.

This is PIFU

It is perhaps fitting to footnote a summary of “What is PIFU?” with a quote from an NHS patient, as sourced from NHS England:

“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”.

The not-so-secret ingredient that makes PIFU so potent is the mutual understanding and acknowledgment that a patient wants to be seen because they need to be seen.

From a clinician’s point of view, a patient may present with credibility if they have exhausted other avenues during their PIFU, such as educating themselves about their condition, or following their pathway through a digital healthcare app.

Perhaps the future of patient power truly does rest in the palm of a patient’s hand.