Rethinking patient initiated follow up (PIFU) and learning lessons in triage from primary care could reduce the burden on services that aren’t needed, help clear the patient backlog, and improve staff morale and patient satisfaction, says Jacob Haddad, chief executive and co-founder of Accurx.
The delivery of healthcare should go far beyond the four walls of a GP practice or hospital. Simple technology, such as two-way messaging, remote monitoring and online consultations can enable patients to receive care in a personalised and timely manner, often sidestepping the need to wait for a face-to-face appointment.
We saw the sudden growth in use of these technologies - mostly across primary care - as a result of the pandemic, when seeing patients in person was no longer an option. One area where we’ve seen vast impact is the move to triaging patients in general practice. This has led to more care being delivered digitally outside of appointments, such as the ability to remotely share an image of a skin condition or approving a repeat prescription. This allows practices to care for more patients, and frees up in-person appointments for those who need to be seen. In primary care we’ve found that 25-30 per cent of medical requests can be resolved without the need for an appointment.
…patients also need a clear way of initiating conversations with hospital services beyond face-to-face appointments
But patients also need a clear way of initiating conversations with hospital services beyond face-to-face appointments, and an area where we believe this could have a great impact is with patient initiated follow up (PIFU), where outpatients can initiate care. We believe that integrated care systems can take the successes from primary care and implement a model of triage across all outpatient specialities.
Why? Because current methods of PIFU aren’t working. Trusts implementing PIFU often use a phone line for patients to get in contact, however, they’re expensive to staff properly and make it difficult to get input from colleagues (eg. a patient’s named consultant) on what action is required. Additionally, unprecedented demand means these phone lines see high call volumes and patients are waiting longer for calls to be answered than service leaders would like, leading many to revert back to their GP or attend A&E to get help. As well as resulting in a poor patient experience, this can also be inefficient for staff and ultimately cause delays in treatment time.
Quick and effective triaging solutions give patients a clear route of contact to get the support or advice they need when they need it
Quick and effective triaging solutions give patients a clear route of contact to get the support or advice they need when they need it, without waiting months to be seen in person, and offer healthcare professionals a way to manage requests so they can provide better and faster care for patients.
This, in turn, will free up appointments for more urgent care and reduce waiting lists across the NHS. It will also empower more shared decision-making and greater patient self-management, in line with the NHS’s personalised care agenda.
If this was adopted more widely, giving staff the means to triage to reduce the burden on services that aren’t needed, we believe the backlog of patients could be cleared faster, which would in turn improve staff morale and patient satisfaction.
In our latest report, Rethinking PIFU: More than patient-led booking, we outlined that this approach could reduce 2.5 million unnecessary patient follow-up appointments per year under current targets, and give back £300 million each year that the NHS could use towards caring for patients in need.
In-person appointments will always be an essential part of healthcare, but safe and effective care can and does happen outside of appointments. In today’s challenging environment, we feel this could make a huge difference to staff morale and patient satisfaction, as well as helping to clear the backlog. And it doesn’t just have to start with outpatient PIFU - we firmly believe this approach can be applied throughout the entire health system.
Jacob Haddad is chief executive and co-founder of Accurx. You can follow Jacob on Twitter @jacobnhaddad