Patient Initiated Follow Up

Giving patients greater control over their hospital follow-up care

In August 2020, NHS England provided further guidance on Phase 3 of the COVID-19 Recovery Plan, highlighting the need to give patients greater control over their hospital follow-up care for example, by using a Patient-Initiated Follow-Up (PIFU) model.

Implementing a PIFU approach to the patient pathway empowers patients to manage their condition while giving them the ability to arrange appointments only where required - rather than as a routine follow up. This plays a key role in creating capacity, reducing demand and enabling shared decision making for more effective self-management in line with the COVID-19 recovery plan and the personalised care agenda.

NHS organisations have until 21st September to put forward their final proposals to NHS England on how to meet the PIFU requirements.

The information below provides essential guidance to demonstrate how healthcare professionals can mobilise the Patients Know Best (PKB) platform to transform the delivery of NHS services in response to COVID-19 by using the PIFU model. This is fundamental to prepare our NHS hospitals for winter pressures and a potential second wave, while reducing the inequalities in service provision caused by the pandemic.

Patient guidebook

Use the Library feature to share clinically verified information with patients in their record.

Effective guidance and instructions to empower self-care can reduce the need for face-to-face care.

Top tip!

Upload videos on best practice approaches to self-care.

Remote monitoring

Use Plans to create personalised care plans and provide patients with information and guidance on how to manage their conditions and understand when and how to access the right clinical input when required.

Top tip!

Encourage patients to share care plans with their wider multidisciplinary teams including GP’s and pharmacist's etc for integrated care.

Remote monitoring - escalation points

Agreed escalation points can be created using a Traffic Light System within the Care Plans feature to help patients understand when something isn’t right and when they should seek support.

All professionals i.e. nurse specialists, can track changes, intervene and create personalised self-management plans to support patients to manage their condition based on their symptoms.

Symptom tracking

Use the Symptom Tracker to allow patients to plot their symptoms, enabling them to notice changes in their condition and act upon it.

Top tip!

Monitor changes over a period of time to help spot any early warning signs and deterioration of conditions.

Share test results

Use the Test Results to educate patients about their condition, and to support them spot when changes may be required in how to manage aspects of their care.

Did you know?

Evidence collected from the NHS organisations using PKB shows that access to test results improves care co-ordination, reduces anxiety for patients and means time spent during appointments is used more effectively.

Advice hotlines

Create an ‘Advice Hotline’ by enabling asynchronous messaging between clinician and patient to check in when required to share advice, support and guidance on how they can manage changes in their health.

Top tip!

Use the Library, Care Plans and messaging features to instantly share information with patients in real-time. You could also ask patients to keep a journal or track symptoms until any follow up consultation is needed.

Pre-appointment questionnaire

Give patients the ability to share essential information with healthcare teams prior to booking their appointment using the Consultation feature.

Top tip!

Use this feature to triage patients care and create capacity for patients that most need support.

Need further support?

Please speak to your Success PM for any help and support to use these features.

For more information about how other organisations are using Patient-Initiated Follow-Ups with PKB, please visit our website at