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Many patients with long-term conditions, or following hospital treatment, are asked to meet with their clinical team regularly. However, those follow-up appointments don’t always need to be at routine intervals, but just when the patient needs them.

This is why Ashford & St Peters NHS Foundation Trust has now launched Patient Initiated Follow Up appointments - [PIFU for short].

This type of appointment allows you to arrange a follow-up appointment for you, or someone you care for, only when you need it. This is an alternative to a routine follow-up appointment, which can sometimes be inconvenient, stressful and an unnecessary expense. This means you avoid unnecessary appointments, saving you time, money and stress and means better access to follow-up care when you do need it. The approach is similar to ‘open access appointments’ which you may already be familiar with.

Our aim is to make it more convenient and easier for you to access specialist care when you need it, in a way that meets your lifestyle and preferences.

We are changing the way we deliver outpatient care to better suit you. We are putting you in control and giving you more choice over how and when you access your care so it’s easier and more convenient to receive specialist care in a way that better suits your lifestyle and preferences.

Many patients with long term conditions, or following hospital treatment, do not always need follow-up appointments at routine intervals. Instead, some patients will be offered 'PIFU. This is where you can arrange a follow-up appointment as and when you need it, for instance when your symptoms flare up or if your circumstances change.

Please note that your care is, and always will be our top priority and this will not affect you in a detrimental way.

If PIFU is available and suitable for you, the healthcare professional responsible for your care will discuss this option with you and if you are happy, they will ask you to arrange your appointments in this way in future.

If you think PIFU might work for you, ask us about it at your next appointment with us.

Frequently Asked Questions

What is a Patient Initiated Follow-Up [PIFU] appointment?

  • PIFU describes when you, or a carer or family member on your behalf, arrange your follow-up appointments with us when you need to see us. This means that you are in control of making your own follow-up appointments at a time when you need them, or when your circumstances change
  • Having control of your hospital follow-up appointments provides you with direct access to guidance and support from healthcare professionals as when you most need it.
  • Previously, it has been standard practice for patients who have been seen in an out-patient clinic to be followed up at regular intervals. Some patients find these regular visits useful and reassuring. However, others find them a source of anxiety and not particularly helpful unless they have a specific concern they wish to discuss with their Doctor or Nurse.
  • There is also good evidence that, for the majority of patients, routine follow up at regular intervals does not benefit them and they do not actually need it.

How does patient initiated follow up work?

  • Your healthcare professional will discuss with you the symptoms to look out for that would mean you should make an appointment and how to contact the service if you need to. You will get the chance to discuss any concerns you might have. Depending on your condition, this might replace your routine follow-ups that you might have had in the past.
  • You will also be told whether your PIFU has an end date. If you think you need to be seen again after that date, you will need a new referral.


Why did you introduce this type of follow up?

  • We are offering this type of follow up because it offers a number of benefits. These include:
    • PIFU puts you in control of your own out-patient follow up. Appointments can be made based on your individual needs instead of being at routine intervals, which often do not add value for patients and waste valuable resource. If you experience a flare-up in symptoms, you will be able to receive guidance when you need it - This is referred to as being on a ‘Patient Initiated Follow-Up pathway’.
    • Patients frequently spend time and money to attend regular appointments that are not essential. The number of people making these journeys will be greatly reduced and we hope it will improve your experience.
    • PIFU helps to ensure that you do not have to wait to get an appointment when you really need one
    • Freeing up appointments means we can reduce the waiting times for people who need an appointment, enabling them to be seen more quickly.
    • It will also help us to cut down our carbon footprint by reducing the number of unnecessary journeys made to our hospitals.

Is Patient Initiated Follow-Up suitable for all patients?

  • No, Patient Initiated Follow-Up is not suitable for everyone, your clinician will make the decision with you about whether this is the right thing for you based on your condition.

Why might Patient Initiated Follow-Up be right for me?

  • We believe that, when people have lived with their condition for a while, they become the ‘expert’. Therefore, rather than us calling you for appointments when you might not need to be seen, we are suggesting that you call us when you need us.
  • Patient Initiated Follow-Up can be suitable for those who:
    • have a condition that has visible signs and symptoms that enable them to see when things are not going so well
    • have access to a telephone and the ability to get in touch with us when they need to

When should I contact the service?

  • Please contact us to arrange an outpatient appointment if you experience any problems with your presenting condition or complications after treatment. Your clinician will have already informed you how long the patient-led follow-up period will be. After this time, if we do no hear from you, we will discharge you back to the professional who referred you to our service.
  • If you think it might be an emergency and you’re not sure what to do call NHS 111
  • For all other medical problems, please contact your GP in the usual way.

How do I book a patient initiated follow-up appointment?

You should have been given details on how to contact the service for a new appointment if you haven’t please ring the number on your last appointment letter and say that you need to make a “patient initiated follow-up appointment” and you will be given an appointment as soon as possible. Please note that if you speak to an administrator, secretary or receptionist, they cannot give clinical advice. If you don’t know the number to call please call 01932 722000 and ask to be put through to the clinical office for your speciality e.g. cardiology.  

If you are requested to leave a message, please ensure that you have the following details:

  • your name and your date of birth
  • your NHS number- (this can usually be found on any correspondence you have received from the hospital such as an appointment letter)
  • the telephone number you would like us to call you back on
  • that you are on a PIFU pathway
  • the reason you are calling e.g. I need to request an appointment

In some areas a doctor or specialist nurses will call you back to discuss your concerns further and see if you require a face to face appointment. It may be possible for us to provide the help or advice you need over the telephone or arrange to see you over a video link (virtual appointment/Attend Anywhere). However, if we need to see you in person then an appointment will be arranged for you. A qualified, appropriate clinician will always make the decision on what further appointment you may need.

  • Please remember that it is important that you are available for your appointment. If you find you cannot attend, please tell us in advance so we can try to give your appointment slot to someone else. Failure to let us know you are unable to attend may lead to you being discharged back to your GP.
  • Further general information including travelling to one of our hospitals will also be available on our website here.

How long will I have to wait before I receive an appointment?

  • We have a number of ‘reserved’ appointments every week for people on a PIFU pathway who contact us and need an appointment with a member of the team. The clinical team will decide how quickly you need to be seen. Please be aware that if it is an emergency that needs immediate attention you should call NHS 111 or, if needed, attend the emergency department. PIFU is not to replace emergency care as you should expect to wait around 2 – 4 weeks for an appointment.

Could I get lost in the system?

  • No. You will continue to be a patient under our care and placed on a dedicated waiting list for PIFU, which will be checked regularly. If you do not need to see the Doctor or Nurse at all within the specified period after your last appointment, you will be discharged back to your General Practitioner (GP) who will re-refer you if you need to be seen again in the future.
  • The length of time that you will remain on the PIFU waiting list is determined by your clinician as it depends on your condition and their clinical judgement on how long each patient will need before they can be discharged back to their GP. Furthermore, the length of time you will remain on a PIFU pathway will be discussed and agreed with you when you decide to go onto a PIFU pathway.
  • If and when we see you, you want to go back to having regular outpatient review appointments that is acceptable. However should you wish to remain on a PIFU pathway; we will again agree the duration with you. The same process will then be followed when that pathway comes to an end. In other words, you will be sent an appointment to attend an appointment for a review and you will be asked again whether you wish to remain on a PIFU pathway.
  • If, when you are seen you, the specialist has concerns about whether PIFU is still right for you, they will discuss this with you. You will then be able to make the decision together.

Do I have to agree to Patient Initiated Follow-Up if it’s being offered to me?

  • No, you do not have to agree to Patient Initiated Follow-Up if you don’t feel it’s right for you at this time. Your decision will not affect your care in any way. You will continue to have regular follow-up appointments as before.

Will my GP know that I am on a Patient Initiated Follow-Up pathway?

  • Yes - your GP will be told that you are on a Patient Initiated Follow-Up pathway. They will also know how long you will remain on that pathway and when you are due to have a review with the team.

Patient Initiated Follow (PIFU) helps to keep patients at the centre of their care and treatment by giving them the flexibility and control to access specialist clinicians when they need it most. “Our experience is that PIFU can give patients the confidence to contact specialty teams so that flare ups don’t escalate and coupled with a bolstered use of the advice and guidance interface with primary care, PIFU simply allows a more optimal use of specialist expertise.”

Dr Paul Gazzani, Consultant Dermatologist, University Hospitals Birmingham NHS Foundation Trust


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