Implementing digital PIFU pathways does not have to be a difficult or lengthy process, explains Concepta Wayment, former Associate Director of Operations within the NHS and VP of Transformation at Healthcare Communications. She outlines the many benefits of PIFU, while dispelling some of the myths that often hold trusts back.
Patient Initiated Follow-Up appointments (or PIFU for short) have been identified as a tactic for the post-pandemic recovery, specifically to help reduce the huge and ever-increasing backlogs the NHS is faced with. NHS England has set trusts the target of reducing outpatient follow-ups by a minimum of 25% (against 2019/20 activity levels) by March 2023, and they will also be required to move or discharge 5% of outpatient attendances to PIFU pathways.
The issue is laid bare in the fact that outpatient appointments have nearly doubled to 120 million per annum since 2007/08, with follow-ups accounting for two-thirds of all appointments. And remarkably, as many as 22% of these appointments do not go ahead because the patient fails to attend. This is clearly unsustainable, and so it was obvious that something needed to be done. The answer? PIFU.
PIFU is proven to effectively reduce unnecessary appointments, decrease the number of ‘did not attends’ (DNAs), whilst also increasing patient engagement and patient satisfaction levels. It is also a key enabler for remote monitoring, with patients periodically providing information on the status of their condition – which is a priority for the NHS at present. It is for this reason that PIFU featured as part of the NHS Long Term Plan well before the COVID-19 outbreak, which has done little more than exacerbate the need to stem the trend of swelling appointment numbers.
Many patients with long-term conditions will have regular follow up appointments. Often, these are set at 6-, 9- or 12-month intervals regardless of the clinical need. They can be at times that are unsuitable for the patient, or at a time when the patient may feel their condition is stable, which can lead to the patient not attending. Additionally, patients who experience critical flares in their conditions struggle to get a timely appointment with their clinician, which could result in an A&E visit. PIFU can help to solve this simply and efficiently.
Digital PIFU implementation is not difficult
Given the many benefits that PIFU can offer, it is easy to see why trusts are keen to implement digital PIFU models. Adding to the appeal is the fact that implementation can be straightforward, with many trusts already operating manual versions of PIFU pathways. These pathways can be very simple to digitise, making the implementation of digital PIFU models a quick and easy way of providing a better patient experience, enabling clinicians and patients to jointly plan their care, whilst also freeing up nurse capacity and saving appointments, which is particularly important given current staffing issues.
Working with many trusts, we know that Gastroenterology Departments often provide a “hotline” service for patients undergoing care for Irritable Bowel Syndrome (IBS). This is essentially a PIFU pathway, with nurses triaging calls from patients who were experiencing problematic symptoms. We are now working with several trusts to digitise this process, which we anticipate will provide significant time savings, leaving the nurses free to assist with consultants or see other patients.
Deploy PIFU in 4 weeks
One barrier that I hear time and time again as to why a trust hasn’t implemented PIFU is that they don’t have time. However, I would argue that they don’t have the time to delay implementing PIFU. Once the triage questions are agreed for the specialty, implementation can take just four weeks and the trust will start to see the benefits very quickly.
Recognising this, Kings College Hospitals NHS Foundation Trust (KCHFT) has now contracted us to deliver a transformation support project that will see PIFU implemented across the trust. The first phase of this will see digital PIFU pathways implemented across 18 specialties including Therapies, Orthopaedics, Gynaecology, Urology, Gastroenterology and Paediatrics.
The benefits are tangible and readily proven, so it is understandable why NHS England has introduced the PIFU targets to drive widespread uptake. But why did they need to do this? What are the barriers that have prevented trusts from implementing PIFU sooner?
Digital equality and PIFU
There is one widespread myth within healthcare that just won’t abate, which I think has contributed to the delay in uptake so far: that older patients won’t manage digital communications. This just simply isn’t true! The pandemic has shown us just how adept older people can be at navigating digital appointments and communication channels, with many of them actually preferring it. However, this is also a moot point when it comes to PIFU, as the clinician will always have a discussion with the patient before agreeing together that they will be placed on a PIFU pathway. Generally, it will be appropriate for those patients whose condition is stable, who are comfortable assessing their condition and know when to request an appointment, and who are comfortable with the technology.
It is also important to stress that PIFU is not a one-size-fits all approach. In fact, it can be very bespoke with the automated patient contact set for different times and either time limited (for example it will automatically end after 6 months if a patient hasn’t triggered contact) or open-ended. The clinician can decide this according to the patients’ needs.
At Healthcare Communications, our PIFU technology is available via an online patient portal, SMS or chatbot. Through the portal, patients simply register and click on their ‘follow up’ tile whenever they need to initiate contact. Any check-in questionnaires can also be accessed from the portal.It is a standalone module and so it has the ability to integrate with a trust’s existing communication portal. The chatbot is conversational, enabling the patient to communicate through their channel of choice, empowering them in their healthcare.
Unexpected benefits of PIFU
PIFU can also reap other less obvious benefits, as Homerton Hospital realised when we implemented PIFU for its endometriosis patients. As a tertiary referral centre for complex or severe endometriosis that is accredited by the British Society of Gynaecological Endoscopy, the hospital is required to monitor its patients for two years and needs to be able to demonstrate that it is doing so during regular audits. This can be achieved very easily through the data it is collecting via PIFU questionnaires. Further to this, the data may open up opportunities for research – particularly for comparison studies looking at the effectiveness of various treatment options.
Gynaecology is one speciality that really lends itself to the use of digital PIFU pathways and, following the success of its use in Homerton Hospital, we are seeing enquiries from many other trusts. In fact, University Hospitals Dorset NHS Foundation Trust has approached us to provide PIFU services across the trust and, like KCHFT, it is planning to implement it across many specialties.
Why wait?
I am heartened by the volume of enquiries we have received about PIFU, and I am confident in its potential to reduce waiting lists and help to address the current backlogs plaguing the NHS. It offers a simple and effective way in which the NHS can adapt to cater for current and future patient needs. My one rallying call to the NHS trusts yet to implement digital PIFU pathways, is to make it a priority. Get it in your business plans today.
About the author
Concepta Wayment has extensive NHS operational and transformational management experience, having worked as an Associate Director of Operations within the NHS, where she led a 500-strong team to achieve significant improvements and efficiencies against NHS Trust Development Authority improvement plans.