An initiative that puts patients in control of requesting follow-up care is reducing waiting lists – and improving patient satisfaction.
When chronic pain sufferer Sarah-Jane Webb, 37, from Margate was about to start a new job as a parent support worker, it was important to her to get support that didn’t impact on her new role.
She was offered a patient-initiated follow-up (PIFU) with Kent Community Health NHS Foundation Trust’s Community Chronic Pain Service and could choose a time that suited her.
Sarah-Jane (pictured, top) said: “I was starting a new job and so rather than having a time and date sent to me, which might not be convenient, I was able to call back and arrange something around work and family at a time which suited me. I phoned and had an appointment within two weeks.
“At my appointment with the chronic pain clinic, I felt it was nice to be understood. I’ve now been offered an eight-week course to learn how to cope with pain.”
The new way of working has been introduced in the trust’s Integrated Musculoskeletal Service, which covers physiotherapy, chronic pain and community orthopaedics. It has allowed people to get in touch if they feel they need more support and to book another appointment when it fits in with their other commitments. With only those who need appointments booking them, rather than these being automatically scheduled for everyone, this has freed up many slots, enabling the service to see others on the waiting list sooner.
PIFUs are letters or leaflets which are given to patients with details of how to get back in touch. They are often given to those who have had treatment, but may not feel ready to be discharged. Having a PIFU is a direct line back into the service, without the need for a GP or healthcare professional to do another referral. Patients can use their PIFUs for a set period, which can be up to six months, being able to return for the same condition for which they were originally referred, but not for something new.
Previously, clinicians would book a follow-up appointment after a set amount of time and ask the patient to do exercises, homework, or perhaps read advice on websites in the interim, but were finding many people hadn’t done this and there was little to discuss or review.
Operational Quality Manager Natalie Dawson said: “We were finding that some people had not done things we’d asked them to do between appointments, as they’d forgotten, were not able to, or perhaps something had happened, such as a bereavement, or they had started a new job.
“So sometimes, asking a patient to come back in six-months-time, wasn’t very useful, with neither the clinician or the patient gaining anything from this. Also, some people didn’t feel they needed a follow-up.
“Changing the way we do things has put the patient in control and only those who want to continue engaging with the service do so, contacting us when they are ready and when the time is right for them.
“Not booking in routine follow ups for everyone we see releases capacity in the diary, so other people can be seen in just a few weeks, rather than having to wait months.”
The trust has been using PIFUS in the IMSK service since April 2023 and in the first 16 months they were handed to around 1,500 patients to date. The work has been led by Consultant Chronic Pain Nurse Lesley Wright, with the aim of improving patient care.
Natalie said: “Initially with colleagues there was some trepidation and they were nervous about handing control to patients, worried that they would not come back and forget about us, but over time they have seen the benefits of seeing patients at the right time for them.
“Most patients are happy with this process. With the PIFU, they are given advice on what to do if they have issues, what to look out for and are given guidance.”
The team used a quality improvement (QI) approach, after identifying that there were a lot of wasted appointments in chronic pain and long waits for follow-up appointments.
