What is PIFU? Patient Initiated Follow-Up in the NHS
9th October 2025
What is PIFU? Put simply, it gives patients and carers control of their follow-up care. Follow-up is an effective method for maximising capacity and monitoring patient health, but in many trusts it varies. It can become a conveyor belt of routine appointments. More trusts are adopting Patient Initiated Follow-up because it helps optimise outpatient pathways and supports patients to wait well.
If you want the practical “how to”, see our guide to implementing Patient Initiated Follow-Up.
In this article, we’ll answer the following questions for you:
-
What does PIFU mean?
-
What does PIFU mean in the NHS?
-
What are the benefits of PIFU?
-
Traditional follow-up versus PIFU
-
How does PIFU work?
-
How might PIFU pathways vary?
-
How Netcall can help
What does PIFU mean?
Patient initiated follow up (PIFU) is a simple model where people can book their own review when they need it, rather than being given fixed routine slots.
In outpatient clinics across the NHS, it’s usually offered to people whose condition is stable and who understand when to get in touch, once a clinician has confirmed they are suitable. The term means exactly what it says, a patient chooses when a follow-up appointment is right for them and in the NHS it sits inside agreed pathways with clear safety nets, so no one is lost to follow up. Patients are given a set window to contact the service, for example 6, 12 or 18 months. If they do not need an appointment in that time, they are normally discharged.
What does PIFU mean in the NHS?
There are many benefits of PIFU, but in this instance, we’ll look at three everyday problems PIFU tackles in the NHS:
-
It gives patients more control over their health
-
It cuts routine appointments that add little value
-
It removes the worry that comes from waiting for a date for an appointment to arrive.
PIFU also supports broader NHS aims to reduce the backlog and help people wait well while they are under outpatient care. For a wider view, read our background on the NHS waitlist problem.
Applications and industry
PIFU is already embedded across multiple specialties, for example:
-
Ophthalmology for stable glaucoma patients
-
Rheumatology for stable inflammatory conditions
-
Dermatology for long-term skin conditions
-
Cardiology for patients with stable symptoms
-
Orthopaedics for post-op or conservative management where red flag advice is clear.
What are the benefits of PIFU?
From a patient’s point of view, PIFU means shorter waits for the appointments that matter. It cuts travel and time off work and it avoids unnecessary hospital visits when their condition is steady. Anxiety eases because there is a clear route back with red flag advice and simple contact details. Most of all, people gain more control of management of their care and can recover well knowing the door is open if symptoms change.
For NHS services, PIFU frees up clinic time for those who need it most. Administrative workload reduces with fewer recall letters and calls, patient flow improves and scarce capacity is used where it adds the most value. Engagement tends to rise because instructions are clear and access is simple. Digital follow-up and messaging also provide reliable audit trails and data that support safety, audit and planning.
Many trusts have shown these benefits in practice. At The Rotherham NHS Foundation Trust, digital tools have improved patient communication and helped reduce pressure on waiting lists, demonstrating what is possible when trusts make it easy for patients to take control of their health journey by improving digital accessibility.
Traditional follow-up versus PIFU
| Traditional Follow up | Patient-initiated-Follow-Up |
|---|
| Scheduling | Fixed routine slots booked by the hospital | Patient books on demand within an agreed window |
| Trigger | Time based recall lists | Symptom based, the patient gets in touch when things change |
| Patient experience | Unnecessary visits and long gaps between reviews | Seen when needed with clear advice and a safety net |
| Safety net | Back up lists, letters and phone calls | Written red flag advice, open return route, digital prompts near the end of the window |
| Use of capacity | Many slots taken by low value routine reviews | Slots kept for people who are deteriorating or have new concerns |
| Communication | Letters and manual booking by admin teams | Self service via Patient Hub, SMS and the NHS App, with a full audit trail |
| Accessibility | Works best for people who can attend on set dates | Flexible booking with telephone and digital options for those with work or caring duties |
| Typical use | All patients on a pathway are recalled at set intervals | Only clinically suitable patients are enrolled, with discharge to the GP when the window ends |
How does PIFU work?
PIFU pathways can vary between trusts, but in practice the pathway can be very straightforward. At the first clinic visit the clinician explains how PIFU works, checks the person is clinically suitable and agrees what to watch for. The patient leaves with clear written guidance, contact routes and a review window, for example twelve to eighteen months. If symptoms change during that time the patient gets back in touch by phone, a secure portal or the NHS App.
Queries are triaged to the right team and, if needed, a follow-up slot is booked without the back and forth of letters. Red flag advice is explicit so people know when to bypass PIFU and seek urgent care.
Near the end of the window an automatic nudge can remind patients about their options. If they have not needed an appointment, they are usually discharged back to the regular care of their GP with advice about when to return. Each interaction creates a clear audit trail and protects clinic capacity. In short, follow up happens when it matters, with a safe route back if things get worse.
For practical steps and templates, see our guide to implementing Patient Initiated Follow-Up.
How might PIFU pathways vary?
There’s no one-size-fits-all model for PIFU – and that’s its strength. Pathways flex around local risk, resources and population needs, giving teams the freedom to design safe and sustainable services. Teams set selection criteria and exclusions. Some enrol only people with stable disease and strong self-management, others include post op patients once healing is checked. Monitoring ranges from light touch written advice to active follow up using short symptom checkers, photo upload for flares and simple logs such as peak flow or blood pressure. Services for children and for frail patients layer in extra safeguards. Communication routes also vary. Most offer a phone line plus a portal or the NHS App, with adjustments for language needs, carers and people with limited digital access.
Safety nets are tuned to local risk. Teams choose the review window, send automatic nudges as it nears the end and hand back to the GP with clear return advice when the window closes. Fail-safes prevent people being lost to follow up, including monthly lists of those who have not made contact. Capacity rules differ too. Many ring-fence urgent slots for PIFU returns, set triage standards and track return rates, time to appointment, avoidable emergency visits and DNA rates to refine the pathway.
How Netcall can help
Netcall’s healthcare solutions make PIFU simple, secure and scalable. Patients can initiate follow-up through a secure portal, like Patient Hub, SMS or the NHS App. Automated reminders, such as a nudge six weeks before a window expires, keep people informed. A central dashboard helps trusts manage PIFU lists, protect capacity and keep data secure.
The outcome? Shorter waits, smoother patient journeys and clinics freed to focus on care that can’t wait – helping trusts deliver on NHS elective recovery goals while improving patient experience at every step.
About the author
Jonathan Rapley
Senior Solutions Consultant
Jonathan has spent over 30 years working with organisations in all sectors to increase efficiency, productivity and satisfaction through the use of technology. Starting off in contact centre management, through operations management, IT helpdesk management, software training and consultancy, Jonathan brings an eclectic and creative focus to client engagements. Jonathan has always been a tech enthusiast but understands that implementation must align with an understanding of human behavioural psychology in order for change to be successful. When he’s not at work Jonathan relaxes by computer gaming with a cat curled up on his lap and stays active by running and swimming.