Patient-initiated follow-up: will it free up capacity in outpatient care?

With the number of outpatient hospital appointments in England recently as high as 125 million per year and a huge elective care backlog following the Covid-19 pandemic, patient-initiated follow-up on outpatient appointments has been touted as a potential solution in appropriate cases. But can it free up much-needed capacity while maintaining quality of patient experience and outcomes? As the NHS begins to expand its use of the approach, the NIHR RSET research team has conducted a first review of the available evidence.

As the NHS seeks to clear the backlog of elective care that has built up in the wake of the Covid-19 pandemic, one of the solutions being turned to is more personalised follow-up in outpatient care. NHS leaders have called for an ‘industrial’ drive to cut the number of unnecessary outpatient appointments and better prioritise clinical time where it adds the most value – setting the target to reduce outpatient follow-ups by 25% against 2019/20 activity levels by March 2023.

To deliver this, NHS England have set the ambition that 5% of outpatient attendances will be moved to patient-initiated follow-up (PIFU) pathways by March 2023 – a target that is likely to increase in the future. PIFU aims to give more flexibility and choice to patients over the timing of their care and allow them to book appointments as and when they need them rather than follow a standardised schedule. 

But as the NHS seeks to expand PIFU further, there are several open questions about how well it works, and for whom:

  • What is the evidence that PIFU reduces unnecessary appointments and frees up clinical capacity for patients who need it the most?
  • How do patients experience PIFU, and what risks might it involve?
  • How might PIFU affect health inequalities?
  • Are there differences in how patients are selected for PIFU?
  • Are there differences in how well patients are able to access care once on a PIFU pathway by race, age, gender or other patient factors?

This NIHR RSET briefing explains what we know from the available evidence and earlier evaluations of PIFU about how personalising follow-up impacts service use and patient experience and outcomes. We also discuss key implementation considerations for the NHS as it seeks to mainstream this approach. 


funded-by-nihr-logo.png rset-logo-tight.png

Suggested citation

Reed S and Crellin N (2022) Patient-initiated follow-up: will it free up capacity in outpatient care? Briefing, NIHR RSET (Nuffield Trust and UCL), August.

Appears in