Patient Initiated Follow Up (PIFU)

 

Introduction

PIFU describes when a patient, or carer, can initiate their follow-up appointments as and when required. For example, a patient may initiate an appointment when their symptoms change as opposed to receiving a standard timed follow-up appointment.

This helps empower patients to take control of their own care and frees up capacity at providers to see patients when they need it the most. A key principle of the PIFU approach is a shared decision-making conversation between the clinician and the patient.

PIFU is encouraged by NHS England, for example as part of the Cardiac Transformation Programme as well as the Getting It Right First Time initiative to improve patient care. The flexibility and control that PIFU offers patients also aligns with NHS England’s personalised care agenda.

PIFU is not a new concept and has long been used on an ad hoc basis in various specialties. PIFU is already being used within Cardiology in services across South London to varying extents.

Benefits

PIFU has the potential to benefit patients, clinicians, and the wider system. By allowing patients to initiate an appointment when needed, PIFU empowers patients and improves patients’ engagement with their health. Being able to access care when required and experiencing more responsive services improves patient satisfaction. Patients will also save time and money by not having to travel to unnecessary appointments.

PIFU benefits services and clinicians by supporting the management of waiting lists. The net reduction in follow-up appointments that PIFU could facilitate would result in waiting time reductions. This would, in turn, reduce clinical risk and target unmet needs by enabling the most urgent cases to access care quicker. Clinicians will also be reassured that they are seeing the patients who need them the most and that patients know how to contact services when required.

Guidelines

NHS England have produced a range of resources to support the implementation of PIFU. The documents most relevant to PIFU in Cardiology are linked below.

• Arrhythmia – Guide to setting up patient initiated follow-up services for people with arrhythmia
• Heart Failure – Guide to implementing patient initiated follow-up services for people with heart failure
• Heart Valve Disease – Guide to implementing patient initiated follow-up and regular surveillance imaging for patients with mild to moderate heart valve disease

South London PIFU in Cardiology Working Group

The ODN hosts the South London PIFU in Cardiology Working Group.

If you are a healthcare professional working in an acute Cardiology setting in South London and wish to become involved with the Working Group or any other Network activity relating to PIFU, please contact Alis Jones.

Data and Audits

Monitoring PIFU rates is crucial to informing and improving the implementation of PIFU in Cardiology. Understanding the impacts of expanding PIFU is a key priority for the South London PIFU in Cardiology Working Group. Metrics of interest include PIFU usage rates, re-initiation rates, and Did Not Attend rates. This data can be obtained at provider, ICB, and Network levels.

NHS England’s Provider Elective Recovery Outpatient Collection dashboard displays PIFU data. Please note that an NHS log-in is required to access this resource.