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Found 53 results
  1. Content Article
    To give patients and their carers the flexibility to arrange their follow-up appointments as and when they need them, NHS England is supporting providers to roll out patient initiated follow-up (PIFU). PIFU is when a patient initiates an appointment when they need one, based on their symptoms and individual circumstances. It can be used with patients with long or short-term conditions in a broad range of specialties including dermatology, rheumatology and cancer. PIFU is not a new concept, and commonly goes by a number of other names including open access follow-up, patient led follow-up, patient triggered follow-up, patient initiated appointments, supported self-managed follow-up, self-managed follow-up, see on symptom, open appointments, open self-referral appointments or patient-activated care. The approach helps empower patients to manage their own condition and plays a key role in enabling shared decision making and supported self-management in line with the personalised care agenda.
  2. Content Article
    This cohort study in JAMA Network Open aimed to assess how patients receiving radiation treatment for cancer rated their satisfaction with fully remote management by doctors. It also identified the associated safety events, financial implications and environmental consequences. The authors found that: more than 99% of safety events did not reach patients or caused no harm to patients. 98% of patient ratings of satisfaction with fully remote management were good to very good. out-of-pocket cost savings associated with fully remote management totalled approximately $612 913 ($466 per patient). estimated carbon dioxide emissions decreased by 174 metric tons.
  3. Content Article
    Although much of the national press coverage of healthcare in the UK often focuses on the impact of delayed discharges from hospitals, ineffective discharge from mental health settings can lead to higher levels of patient readmission. In this blog CJ Nwasike looks at how discharge without support exacerbates pressure on community mental health services and can risk readmission.
  4. News Article
    NHS England is looking to ditch a key elective target that aimed to deliver large reductions in follow-up appointments, HSJ has learned. Senior sources privately admit progress has not been made against the target to cut the volume of the most common type of outpatient follow-up by 25 per cent target. This is supported by publicly available data. While this only gives a partial picture, the data suggests the volumes have actually increased compared to pre-covid levels. The volume-based target is widely viewed as unrealistic and senior figures told HSJ it had also “masked” some genuine progress trusts have made in reforming outpatient services and reducing less productive appointments. Sources familiar with discussions said having a volume-based target to reduce a subset of patients while trying to increase overall activity volumes had been logistically complex. NHSE is instead pushing for a new “ratio-based” target which sources said would be a better measure to reduce the least productive types of outpatient follow-ups and be a fairer measure of progress. Read full story (paywalled) Source: HSJ, 26 February 2024
  5. Content Article
    ‘Patient-initiated follow-up’ (or PIFU, for short) is not a new idea and has been referred to in different ways over time, such as open-access appointments, self-managed follow-up, and see-on-symptom appointments. However, this approach has been given renewed attention given rising waiting times and the backlog of care that built up throughout the Covid-19 pandemic.  Moving outpatient attendances to patient-initiated follow-up (PIFU) pathways is considered a key part of plans to reduce outpatient follow-ups. But what exactly is PIFU? In this Nuffield Trust explainer, Sarah Reed and Nadia Crellin describe more about what it is, the problems it could solve, and what is known so far about how well it works.
  6. News Article
    A prostate cancer patient went a year without a check-up because his referral to a consultant was lost. An inquest into the death of Thomas Ithell also heard that when the error was spotted it was not recorded because staff at Wrexham Maelor Hospital were too busy. The 77-year-old from Wrexham died in November 2022 after being admitted to hospital with shortness of breath. Assistant Coroner for North Wales East and Central, Kate Robertson, has submitted a Prevention of Future Deaths report to the health board in relation to Mr Ithell's case. As well as concerns over the lack of an investigation, she also questioned how the patient's follow-up appointment was missed. "There have been no assurances as to what, if any, changes and learning have been identified other than a tracking system for PSA monitoring," she wrote, referring to a type of blood test that helps diagnose prostate cancer. She was also concerned to learn that the hospital's Datix system - used for reporting incidents such as Mr Ithell's - had been described as "not user-friendly". Time constraints also sometimes prevented staff from completing these reports, thereby failing to trigger subsequent investigations by the board, the assistant coroner added. "I remain incredibly concerned that where matters are not raised in accordance with internal health board processes that assurances given to me in previous Prevention of Future Deaths reports cannot be supported," Ms Robertson added. Read full story Source: BBC News, 27 January 2024
  7. Content Article
    This document from the Department of Health and Social Care (DHSC) sets out how health and care systems should work together to support discharge from all mental health and learning disability and autism inpatient settings for children, young people and adults. It sets out best practice on: how NHS bodies and local authorities should work closely together to support the discharge process and ensure the right support in the community, and provides clarity in relation to responsibilities  patient and carer involvement in discharge planning.
  8. Content Article
    Thomas Ithell was aged 77 at the time of his death on 20 November 2022. He was diagnosed with prostate cancer in September 2017 and biopsies revealed bilateral adenocarcinoma of the prostate. He underwent radiotherapy in 2018 and hormone deprivation treatment. From April 2021 onwards his PSA levels increased periodically. In October 2021 his level was 5.5ng/ml having been 1.5ng/m lin April 2021 and 2.7ng/m in July 2021 indicating a recurrence of the cancer and likely incurable. Thomas Ithell was reluctant to undergo further hormone treatment as he found tolerating the side effects difficult. He did not then have his PSA levels tested after November 2021 and was not reviewed at all due to becoming missed to follow up. After he had been seen by the nurse practitioner on 5 November 2021, the letter written by the nurse practitioner for advice from the consultant did not reach the consultant. He was reviewed by a consultant on 22 October 2022 after an urgent suspected cancer GP referral following routine set of blood tests in September 2022, some 10 months later. Mr Ithell died in hospital on 20 November 2022 having been admitted with shortness of breath, the malignancy having caused his death.
  9. Content Article
    This study in the British Journal of General Practice aimed to assess the risk of poor respiratory outcomes for people with resolved asthma compared to those with active asthma and people without asthma. The authors used three retrospective cohorts of around 16,000 patients each, in the following groups: Active asthma cohort (patients with an asthma-specific diagnostic code at any point in their GP record, and >1 asthma medication prescription). Resolved asthma cohort (patients with >1 resolved asthma code, followed from date of first resolved asthma during the study period to the earliest data of an asthma prescription, the end of the study period, date of transfer out of practice or death). Non-asthma cohort (population-based patients without active or resolved asthma or chronic obstructive pulmonary disease). The results showed that compared to the active asthma cohort, the resolved asthma cohort had fewer GP consultations for asthma exacerbations and fewer asthma hospital admissions. However, compared with non-asthma patients, resolved asthma patients had more GP consultations, greater rates of respiratory tract infections and higher rates of antibiotic use. The authors highlighted a lack of guidance around care pathways for patients with a record of resolved asthma. They concluded that patients with resolved asthma may need a more comprehensive respiratory assessment if they present with symptoms of lower respiratory tract infection, in order to assess symptom burden, airway obstruction and the potential value of inhaled treatment.
  10. News Article
    Campaigners have said that more lives would be lost unless mental health services were reformed. Figures show 120 people each year are killed by people with mental illnesses. Julian Hendy, whose father was killed by a psychotic man with a long history of mental ill health 17 years ago, said health professionals must be “more assertive” and work better with other agencies such as the police. Valdo Calocane, who was sentenced on Thursday to an indefinite hospital order after being convicted of manslaughter of three people in Nottingham, had fallen off the radar of mental health services, which allowed him to avoid taking his medicine. Hendy accused Nottinghamshire Healthcare NHS Foundation Trust, which was responsible for Calocane’s care, of “washing their hands” of him. He said: “It’s not responsible and it’s not safe. It doesn’t look after people properly … That hasn’t helped him at all, or protected his rights at all, because he has now committed this terrible offence.” Read full story (paywalled) Source: The Times, 26 January 2024
  11. News Article
    NHS England’s drive to encourage patient-initiated appointments is only having a marginal impact on reducing overall outpatient follow-ups, a major study suggests. NHS England currently has a target to have 5% of outpatients on patient-initiated follow-up pathways, and hopes this can be increased substantially in future years. The headline finding in a study by the Nuffield Trust think tank, which analysed almost 60 million cases, was that for every 5% on PIFU pathways, this roughly corresponded to 2% fewer outpatient follow-up attendances overall. It suggests PIFU implementation would need to be dramatically expanded to get anywhere close to a 25% reduction in total follow-up activity, which NHSE had previously targeted by March 2023. As previously reported, there has been little to no reduction so far. Chris Sherlaw-Johnson, senior fellow at the Nuffield Trust, said: “As few patients are currently on PIFU pathways at present, it’s not going to have that noticeable impact on the overall number of follow ups.” He also stressed it was not clear whether the reduction was caused by the genuine elimination of unnecessary follow-ups or if patients were not returning for care despite needing it. Read full story (paywalled) Source: HSJ, 25 January 2024
  12. Content Article
    Millions of people use hospital services as an outpatient, with numbers of appointments rising rapidly over recent years. Patient-initiated follow-up (PIFU) is a relatively new initiative in the English NHS, and the NIHR RSET team has conducted a mixed-methods evaluation as the process develops to understand how it's working and what impact it's having on health care systems and the staff and patients involved.
  13. News Article
    A trust is reviewing more than 100,000 patients on its outpatient lists, after concerns emerged that some had ‘been lost whilst on hold’ for follow-up appointments. A report from Buckinghamshire Healthcare Trust, leaked to HSJ, found 116,575 patient records without a scheduled follow-up after an outpatient consultation, with more than half of those left inappropriately without action, some dating back a decade. The review was triggered after staff spotted cases in which patients had been “lost whilst on hold”, the report said. The trust this week told HSJ that, since the initial discovery in the summer of last year, it had been validating the lists and reduced the number of outstanding records to 47,778. It aims to complete the reviews in the next two months. It told HSJ it had undertaken a harm review and found no “systemic harm”. Concerns have been raised over several years about the extent of overdue and unreviewed patients on follow-up lists, and the potential for them to deteriorate and come to harm. There are no national figures monitoring the patients, many of whom have long-term health needs. Read full story (paywalled) Source: HSJ, 15 December 2023
  14. News Article
    Campaigners have written to the chief constables of Norfolk and Suffolk to request an investigation into thousands of mental health deaths in those areas. They say coroners are raising safety issues but no improvements are being made. A report by independent auditors found as many as 8,440 patients had died unexpectedly over three years. Norfolk and Suffolk NHS Foundation Trust said it had started a review of patient deaths. Coroners worried about the risk of future deaths highlight unsafe practices in prevention of future deaths reports (PFDs). And authorities are required by law to respond with an action plan within 56 days. The Norfolk and Suffolk trust said it had responded to all PFDs and was working to ensure recommendations and actions were implemented. But Mark Harrison, from the Campaign to Save Mental Health Services in Norfolk and Suffolk, said: "There's a criminal case to answer. And we want the police to investigate, where the same mistakes have been repeated time and time again." He said coroners were repeatedly warning of risks such as delays to treatment, lack of patient follow-ups, chaotic record keeping and disorganised communication between teams. Mr Harrison said: "The mental health trust always responds saying they've learned lessons, they are changing policy and practices. "But then what we're seeing in analysing the orders from the coroner are repeat circumstances where other people have died in similar circumstances to a previous prevention-of-future-deaths notice." Read full story Source: BBC News, 12 December 2023
  15. Content Article
    Patient-initiated follow up (PIFU) is an appointment process that helps hospitals manage capacity and puts patients in control of making appointments, when they need them. In traditional care models, patients who have had treatment or surgery, or suffer with chronic conditions are provided with a set care plan and offered scheduled follow-up appointments either conducted in person, or remotely. PIFU offers an alternative way of organising planned follow-up care for patients following their elective procedures, rather than automatically being scheduled for appointments. This aims to give greater control to patients over the timing of their follow-up appointment based on their health status needs, helping patients save time, money and the inconvenience of travelling to pre-arranged appointments they may not need.
  16. News Article
    Patients are being left feeling “confused and neglected” by not being told who to contact about their future care when they are discharged from hospital, an NHS watchdog has said. Research by Healthwatch England has found that 51% of people are not being given details when they leave of which services they can turn to for help and advice while they are recovering. The NHS was risking patients having to be readmitted as medical emergencies and hospital beds becoming even more scarce by failing to adhere to its own guidelines on discharge, it said. “While our findings show some positive examples, it’s alarming that guidance on safe discharge from the hospital is routinely not being followed,” said Louise Ansari, the patient champion’s chief executive. Healthwatch asked 583 people and their carers how their discharge had gone. Read full story Source: The Guardian, 19 November 2023
  17. Content Article
    New research from Healthwatch reveals worrying problems with hospital discharge arrangements. Many people told us they are not given the right support or information when being discharged from hospital. Read on about their experiences and Health Watch's calls to action.
  18. News Article
    NHS patients will wait longer for routine checks as part of a national drive to clear record backlogs. Health officials have instructed hospitals to “repurpose” resources to focus on those waiting the longest, who are yet to have their first appointment. Today the NHS claimed it had “virtually eliminated” two year waits, with less than 3,000 people enduring such delays, down from 22,500 at the end of January. Hospitals are being urged to prioritise those waiting 18 months or more, with pledges to get rid of such waits by April next year. NHS chiefs have instructed hospitals to focus on outpatient first appointments, rather than patients who have already had treatment, and are waiting for follow-up checks. Senior officials have said many such appointments are a “a waste of time” saying there should be more use of systems where routine slots are scrapped, and patients instead told to contact their medical team if they have particular concerns. The drive - which health chiefs dubbed “Super September” - will see priority given to tackling the longest waits. Read full story (paywalled) Source: The Telegraph, 9 August 2022
  19. News Article
    A large acute trust is carrying out a major expansion of patient-initiated follow-up (PIFU) appointments, which is said to be “the most ambitious” project of its kind in the NHS. Norfolk and Norwich University Hospitals Foundation Trust has categorised around half of its outpatient follow-up list as “possible or probable opportunities” for patient-initiated pathways. NNUH wants to make PIFU the “default model” for patients who are not on active pathways, and where it is safe to do this. Its project is being closely watched by national leaders and has already drawn praise from NHS England’s director of elective recovery, Rob Stones, during a webinar last month. It is understood to be more ambitious than NHSE’s official PIFU pilot projects. NHSE’s elective chief, Sir Jim Mackey, has said he wants to expand PIFU pathways on an “industrial” scale. Read full story (paywalled) Source: HSJ, 29 July 2022
  20. News Article
    A new report has condemned ‘serious issues’ with NHS referral processes, amid findings that one in five patient referrals made by GPs went into a ‘black hole’. Healthwatch England said that 21% of people they spoke to with a GP referral to another NHS service were rejected, not followed up on or sent back to general practice. The watchdog said that more support should be given to help GP and hospital teams to reduce the numbers of people returning to general practice due to ‘communication failures’ following a referral. According to the findings, the failures were due to GP teams not sending referrals, referrals going missing between services, or being either booked or rejected by hospitals without any communication. Louise Ansari, Healthwatch England’s national director, said that thousands of people told the watchdog that the process is ‘far from straightforward.’ She said: "Falling into this “referrals black hole” is not just frustrating for patients but ultimately means people end up going back to their GP or visiting crowded A&E departments to get the help they need. "This adds more burden to already stretched services, making things even harder for the doctors and nurses trying to provide care." Read full story Source: Pulse, 20 February 2023
  21. News Article
    People who survive cancer may be at heightened risk of cardiovascular disease in subsequent years, data suggests. However, heart scans may identify early heart damage, potentially opening the door to more tailored follow-up care for cancer survivors. Although previous studies have suggested that people who have been treated for cancer may be at greater risk of future cardiovascular problems such as stroke or heart failure, these have mainly focused on the first year after a cancer diagnosis. Few have looked at longer term risks or included cardiovascular imaging to pinpoint damage that has not yet resulted in symptoms. To plug these gaps, Dr Zahra Raisi-Estabragh at Queen Mary University of London and her colleagues assessed the cardiovascular health of 18,714 UK Biobank participants with a previous diagnosis of lung, breast, prostate, blood, womb or bowel cancer, and compared them with an equal number of participants with no cancer history, tracking their cardiovascular health for nearly 12 years. Almost a third of cancer survivors developed a cardiovascular problem during the study period, compared with a quarter of people in the control group. “This study adds to existing knowledge about the impact of some cancer treatments on cardiovascular disease in cancer survivors,” said Martin Ledwick, the head information nurse at Cancer Research UK. “It may help to inform strategies for how some cancer survivors need to be monitored long-term, especially in situations where they have been discharged from cancer follow-up to the care of their GPs.” Read full story Source: The Guardian, 18 April 2023
  22. Content Article
    This Healthcare Safety Investigation Branch (HSIB) investigation focuses on the systems used by healthcare providers to book patient appointments for clinical investigations, such as diagnostic tests and scans. ‘Clinical investigation booking systems’ are used throughout the NHS to support the delivery of patient care. Healthcare services use paper-based or fully electronic systems, or a combination of the two (hybrid systems), to communicate to patients the time, date and location of their appointment. These systems also produce information for patients about actions they need to take to prepare for their appointment. Written patient communication is a key output of clinical investigation booking systems. This investigation examines the safety implications of patient communications, produced by booking systems, that do not account for the needs of the patient. In addition, it looks at why patients are ‘lost to follow-up’ after an appointment is cancelled, rescheduled or not attended. Lost to follow-up is the term used to describe a patient who does not return for planned appointments (whether for continued care or evaluations) or is no longer being tracked in the healthcare system when they should be.
  23. Content Article
    GP services are the first point of call for many health issues and the gateway to NHS specialist support.  GP teams are highly skilled and may decide that treatment without specialist care is the best action. But when you need specialist support, such as hospital tests or treatment, you may need a referral from your GP team first. New research from Healthwatch highlights that it can be very hard for some people to get a GP referral to another NHS service. And for 21% of people we spoke to, even when they get referrals, they can be lost, rejected or not followed up on. When services don't process referrals properly, it can cause significant frustration, unnecessary anxiety, and even cause harm to patients.  It can also lead to increased demand for either more GP appointments or help from healthcare teams in other parts of the NHS, putting more pressure on already overstretched services.
  24. News Article
    Trusts are being encouraged to adopt a system in which patients initiate follow up appointments by the lastest guidance from NHS England designed to help the NHS recover from the covid crisis. It is hoped the approach can reduce unnecessary demand and therefore help trusts cut waiting lists that have soared as a result of the restrictions placed on hospital activity during the pandemic. Under 'patient initiated follow up' (PIFU) patients decide when they require follow up appointments. They are given guidance as to what symptoms and other factors they should take into account when deciding if a follow up appointment is necessary. PIFU is already used by some trusts, but it has not yet become widely adopted. The plan to increase PIFUs was set out in a guidance published today designed to underpin the “phase three letter” sent out to NHS leaders last week. The guidance, Implementing phase 3 of the NHS response to COVID-19 pandemic , says “individual services should develop their own guidance, criteria and protocols on when to use PIFUs”. The document also sets out some overarching principles. It says services will be rated against the following headline metrics: “total number and proportion of patients on the PIFU pathway; patient outcomes, e.g. recovery rates, relapse rates; waiting times; and DNA rates”. Read full story (paywalled) Source: HSJ, 7 August 2020
  25. News Article
    The aftercare of COVID-19 patients will have significant financial implications for ‘understaffed’ community services, NHS England has been warned. This month the national commissioner released guidance for the care of patients once they have recovered from an immediate covid infection and been discharged from hospital. It said community health services will need to provide “ongoing health support that rehabilitates [covid patients] both physically and mentally”. The document said this would result in increased demand for home oxygen services, pulmonary rehabilitation, diagnostics and for many therapies such as speech and language, occupational, physio, dieticians and mental health support. One GP heavily involved in community rehab told HSJ: “There is a lot detailed information about what people might experience in recovery, but it doesn’t say what should actually happen. “We have seen people discharged from hospital that don’t know anything about their follow-up and the community [health sector] hasn’t got any instructions of what they should be doing or what services have even reopened. This guidance needs to go a step further and rapidly say what is expected so local commissioners can put that in place.” Read full story Source: HSJ, 10 June 2020
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