Early implementation of patient initiated follow up (PIFU) in an adult community MSK service - a service evaluation.

Abstract

To effectively implement PIFU within a community musculoskeletal service. PIFU is when a patient can initiate their follow-up appointments as and when required. PIFU helps to empower patients and gives them control over their care while avoiding appointments that are of low clinical value (NHS England 2022). PIFU has been shown to reduce the number of follow up appointments by 0.8-1.8 (NHS England 2021). The 2022/23 Operational Planning Guidance (NHS England 2023) outlines that 5% of outpatient attendances are discharged to PIFU pathways by March 2023. The objective of this project was to evaluate the feasibility of implementing PIFU. Prior to imp lementation there was a culture of therapy led follow up within the service. Method(s): The electronic patient appointment system, used by the community musculoskeletal service, was manually searched to identify any patients that had PIFU as an outcome code during the data collection period. Each PIFU patient's appointments were analysed to establish if further appointments had been made after being placed on PIFU or if they had been discharged. Data was collected on the number of patient's placed on PIFU, whether PIFU was implemented after an initial appointment or after a follow up appointment, how many patients had been discharged and how many patients returned within the 3-month PIFU period. Between 1st September 2022 and 23rd November 2022 there were 4620 patient contacts in the community musculoskeletal service. During the initial implementation phase, 411 patients (8.9%) were placed on PIFU. 117 patients (7.8%) were placed on PIFU after their initial appointment. Of those patients who were placed on PIFU, 339 (82.5%) were discharged due to no contact within the PIFU period. The first 3 months of data shows the implementation of PIFU in a community musculoskeletal service is feasible. Community musculoskeletal services can achieve the 5% target outlined by NHS England. Clinicians have embraced PIFU and moved away from therapy led follow up. PIFU has empowered patients to self-manage their condition as evidenced by 82.5% of PIFU patients not requiring further follow up. Impact: Implementation of PIFU is feasible for musculoskeletal services and has the potential to reduce low value follow ups which can be utilised for new patient capacity.