Insights, news and views from the team.
July 4, 2022

Rethinking PIFU: Our vision for patient-initiated follow-up

We recently launched our latest report on outpatient pathways Rethinking PIFU: More than patient-led booking. This sets out our vision for unlocking the potential of patient-initiated follow-up to support elective recovery and give staff more time to care for the patients who need it. Here, we capture the main highlights of the report, which you can download in full. You can also get in touch with enquiries or express interest in our PIFU solution at

More than patient-led booking

The elective backlog stands at 6.5 million and growing, with over 320,000 patients waiting more than a year for treatment once they’ve been referred [1]. As such, services are tasked with reducing outpatient follow up appointments by 25% by March next year, with the use of PIFU [2]. 


Today, a number of digital PIFU solutions are being developed. But these largely approach outpatient pathways as a matter of patient-led appointment booking via phone or online.

Our report argues that these PIFU solutions won’t meet patient or NHS needs because:

  1. The phone lines by which patients on a PIFU pathway can contact their clinician typically see high call volumes and there’s not enough resource to manage them effectively.

  2. Given most clinics schedule appointments months in advance, there aren’t typically empty appointments available for patients on a PIFU pathway to book. The only way to create this resource would be for outpatient departments to ring-fence specific clinics for emergent PIFU demand.
  1. Care doesn’t just happen in appointments. Many solutions are based on the idea that an appointment is by default what a patient needs. But in fact, patients on a PIFU pathway get in touch with a variety of queries that don’t necessarily need a hospital appointment. They may need advice to manage their condition, to discuss a flare in symptoms, or a prescription from the hospital. Appointments aren’t always the quickest and most effective solution.

Ultimately, basing PIFU on patient-led booking will mean patients are still unable to access care at the point they need it, and fail to have the intended impact on waiting lists. It also adds downstream effects on burnt-out NHS staff by adding to their workplace pressures.

What’s Accurx’s approach to PIFU?

We believe that triage should be the starting point for PIFU. Today, triaging solutions have already made a decisive impact in primary care, as we've seen through the use of online consultations and Patient Triage. These triaging solutions help services meet high patient demand, reduce appointments that aren’t needed and free up time for direct patient care.

The impact of quick and effective triaging solutions provides key learnings when it comes to getting PIFU right.

Our team believes that NHS providers should use PIFU to open a digital channel of communication which allows patients to get the specialist support or advice they need, without needing to book an appointment. This would enable patients and staff to communicate easily outside the appointment, before a follow-up is even booked. 

It was from our learnings in primary care and our insights into secondary care that we recently built our new PIFU solution.


How does Accurx’s PIFU solution work?

Provided a patient has discussed, and consented to, starting a PIFU pathway, they can use our PIFU solution, following these simple steps:

Patients are able to get in touch the moment they need support, while healthcare providers can manage requests at the next available opportunity. Everyone involved in a patient's care has shared visibility over messages to and from a patient, and can triage the patient or respond to their needs efficiently.

’We currently have 55,000 patients on a follow-up waiting list and 8,500 patients already on a PIFU pathway. We believe that by implementing Accurx’s PIFU solution, we’ll be able to serve even more patients on a PIFU pathway, giving them a clear route to medical support.’ - Simon Pizzey, Head of Strategy and Planning, University Hospitals of Leicester NHS Trust

Our solution enables healthcare professionals to prioritise appointments for patients who need them, while managing other PIFU enquiries quickly and seamlessly over SMS/web messaging. This reduces unnecessary appointments, saves time, and means patients are cared for quicker and more effectively.

Our projections and vision for PIFU

With our PIFU solution, we conservatively estimate that 25% of incoming queries can be resolved through messaging rather than requiring an appointment. We project that the NHS can therefore unlock an additional 2.5 million appointments per year, under its current ambition to reduce outpatient follow-ups by a minimum of 25% against 2019/20 activity levels by March 2023. 

This would give the NHS back approximately £300M each year and help to expand the uptake of patient-initiated follow-up (PIFU) to all major outpatient specialties, in line with plans to move 5% of outpatient attendances to PIFU pathways by March next year. 

We believe services can be more ambitious and should aim to provide a PIFU route for all patients under their care. This should include the relevant ‘backstops’ to ensure that follow up can be triggered if a patient does not make contact. Follow up can happen remotely and at the times most convenient for patients and care teams. Doing this would enable millions more unneeded routine appointments to be freed up and given to patients who need them.

Now is the time to capitalise on the power that digital triage and seamless communication can have for outpatients on a PIFU pathway. This will give patients autonomy, save staff time and support the elective recovery by reducing unnecessary outpatient appointments.

You can download our PIFU report in full here. If you'd like to find out more about Accurx and our digital PIFU solution, we'd love to hear from you. Get in touch by emailing

[1] NHS England and NHS Improvement, June 2022, Statistical Press Notice NHS referral to treatment (RTT) waiting times data April 2022

[2] NHS England, February 2022, 2022/23 Operational Planning Guidance 

[3] Accurx Case Study, 2022, University Hospitals of Leicester NHS Trust