After your appointment
Patient Initiated Follow-Up (PIFU): What It Means and How It Works
After a hospital outpatient appointment, some patients are not given a routine follow-up date. Instead they are told they can arrange one themselves if they need it. In England this is called patient initiated follow-up, or PIFU. This guide explains what PIFU means administratively, how to tell whether you are on it, and what to ask your hospital. It does not tell you when to get in touch: your clinical team's instructions decide that.
What PIFU means
NHS England describes PIFU as giving patients, or their carers, the ability to arrange a follow-up appointment when they need one, based on their symptoms and individual circumstances, rather than attending routine appointments at fixed intervals.
It goes by different local names. Hospitals may call it open access, patient-led, patient-triggered or supported self-managed follow-up. Your letter may use any of these.
PIFU is not the same as being discharged from NHS care altogether. Whether you remain under the service, for how long, and what happens afterwards depend on the arrangement your hospital has made for your pathway.
Why you may not have a routine follow-up booked
If you are on PIFU, there is deliberately no routine appointment in the diary. The idea is that you get in touch when you need to, instead of attending appointments you may not need.
But a missing follow-up appointment does not by itself mean you are on PIFU. PIFU should be agreed with you and explained. If a clinician said a follow-up would be arranged and nothing has arrived, and no one has told you that you are on PIFU, treat it as an appointment that may not have been booked yet and contact the clinic.
If an appointment has disappeared · How appointment booking works
How to tell whether you are on PIFU
Hospitals usually confirm PIFU in writing. Check these first:
- Your clinic or outcome letter, which may be copied to your GP.
- Any leaflet or information sheet you were given at the appointment.
- Hospital letters or documents in the NHS App or your hospital's patient portal, if your hospital uses them.
- If none of these mention PIFU, open access or patient-led follow-up, ring the clinic or consultant's secretary and ask directly.
PIFU and your waiting time
NHS England's referral-to-treatment (RTT) waiting-times FAQs say PIFU should not be used while a patient is on an active RTT pathway, that is, while still waiting to start first treatment. Providers may consider moving patients to PIFU after the RTT clock has stopped, in line with national guidance.
The same FAQs (question 53) say it is not appropriate to put a patient on PIFU because they did not attend an RTT appointment. If you think you were moved to PIFU while still waiting for treatment, or after a missed appointment, ask the hospital to explain the decision.
How to request a PIFU appointment
Use the contact route your hospital gave you, usually a dedicated phone line, email or portal named in your letter. Arrangements differ between hospitals and specialties, including how quickly they respond and how soon an appointment is offered; there is no single national timescale.
When to make contact is a clinical matter. Follow the instructions your clinical team gave you. If you are unsure whether to get in touch, or your symptoms change or get worse, contact the team on your letter, your GP or NHS 111. In an emergency call 999.
How long PIFU lasts and what happens at the end
There is no single national PIFU period. Each service decides how long a patient stays on PIFU for their pathway and what happens when that period ends. Your letter should say; if it does not, ask.
- Am I on PIFU, and for which condition or clinic?
- How long does my PIFU period last, and from what date?
- What happens when it ends: will I be discharged to my GP, reviewed, or contacted?
- What is the contact route to request an appointment, and who answers it?
- Will my GP be told that I am on PIFU and when it ends?
Who to contact
Start with the clinic, the consultant's secretary or the PIFU contact named on your letter. If you cannot get a clear answer about your follow-up arrangements, the hospital's Patient Advice and Liaison Service (PALS) can help.
This guide explains administrative processes only. If your symptoms change or get worse while you wait, contact your GP, NHS 111, or the clinical team named on your letter.
Frequently asked questions
Short answers first. Tap a question to read more.
What is PIFU?
Patient initiated follow-up. Instead of a routine follow-up at a fixed interval, you arrange an appointment when you need one, following your clinical team's instructions.
Why don't I have a routine follow-up appointment?
If you are on PIFU, none is booked on purpose. If no one told you that you are on PIFU and you were expecting a follow-up, contact the clinic: it may simply not have been booked yet.
How long am I on PIFU?
It depends on your hospital and specialty. There is no national period, so check your letter or ask the clinic.
Does PIFU mean I have been discharged?
Not necessarily. What PIFU means for your care, and what happens at the end, depends on your hospital's arrangements.
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Sources & references3
Reviewed against publicly available NHS England RTT guidance and the NHS Constitution.
Editorial transparency
How this guide was put together
- Reviewed against the latest publicly available NHS England RTT statistics and guidance.
- Written and edited by the NHSWaitHelper editorial team.
- Cross-checked against the NHS Constitution and operational guidance.
- Independent — no paid hospital rankings, no hidden sponsorship.
NHSWaitHelper is an independent information platform and is not affiliated with the NHS. We do not provide medical or legal advice. Always speak to your GP, clinician, or a regulated adviser about your individual circumstances.