Patient and Professional Initiated Follow-Up (PIFU)

What is Patient and Professional Initiated Follow-Up (PIFU)?

PIFU is an optional care pathway for some people who are waiting to have their final surgery.

Currently, most people waiting for surgery are seen every 6 months by a doctor or nurse for a review of their treatment. Not everybody needs such regular reviews and this can lead to wasted appointments, which could be given to other people and used to shorten the waiting times.

People on the PIFU pathway only have appointments, if and when they need them, while they are waiting for their surgery. On the PIFU pathway, you would be discharged from the service on the understanding that you would get in touch with the clinic in any of the following situations:

• Your feelings about surgery change. You may decide that now is not the right time for surgery, or that you wish to change what surgery you are having.
• Difficulties with hormone treatment. You might have problems with your prescribed medication due to shortages, issues with abnormal blood results, or wanting to change the form that your medicine comes in, e.g. changing gel to injections or tablets.
• Changes to your physical, or mental, health. If something changes that means that your mental or physical health gets worse and you may need to consider pausing surgery until it gets better. We can support you through this time and it may not be necessary to pause your surgical referral.
• Changes to social circumstances. This might be things like being made unemployed or homeless, difficulties with relationships or financial hardships which all may impact on mental health and wellbeing. Not every change means that you need to contact us, only ones that mean that surgery would be hard for you to manage.
• After surgery – we need to see you for a final review of your care and treatment before discharging you fully back to the care of your GP. This review usually takes place 3-6 months after surgery. It is important to note that the NRGDS is not told when your surgery takes place, so we need you to tell us when you are given your surgery date.

PIFU is an option – not everyone will want to use the PIFU pathway. You can come back to the service and have regular appointments again at any time if your needs change. If you ask for an appointment when you are on the PIFU pathway, the service will aim to offer an appointment with a PIFU clinician within 4 weeks.

Who can use the PIFU pathway?

The PIFU pathway is for people who are:

• Waiting for their last planned surgery, and
• Can manage their own healthcare without needing NRGDS to support them regularly,
• Are confident to seek support if and when they need it.

We can only offer PIFU to those who have consented to being contacted by e-mail and telephone.

Once you have been referred for your last planned surgery, the doctor or nurse will talk to you about PIFU, and ask if this pathway is something that you would like to consider. If you and your clinician agree that PIFU is right for you, you will have a conversation and fill in a consent form.

What happens once I am on PIFU?

Your clinician will write a letter to you and your GP. This letter will include the arrangements for contacting the service to request an appointment once you have been discharged.

You will not need to be re-referred by your GP or self-referral if you are on the PIFU pathway. If your GP has any concerns about blood results, or your medicine or if you have any questions, you can contact us as usual or book an appointment directly using the contact details below.

Most people, would not need to see a clinician whilst on this pathway, and would only need to remember to book an appointment following their surgery to arrange final discharge from the service.

How to book an appointment on PIFU?

• If I need an appointment with the PIFU Clinician I can contact the service in one of the following ways:

Phone: 0191 287 6130

E-mail: [email protected]

• When you contact the service you will have to give the following information in order for the NRGDS to find your Electronic Patient Record:

Full name

Date of birth

E-mail address, or telephone number

Current address

• In addition, you will need to provide brief details about the issue you are having so that the team understand how best to respond to your request.
• Once the service has received all of the information, they will aim to contact you to arrange an appointment according to your needs within 4 weeks.

What happens if I cannot attend a planned PIFU appointment?

It is important that you let us know as soon as possible, at least 24 hours in advance, if you cannot attend your appointment. This is so that we can offer that appointment to someone else. Unused appointments add to waiting time for other people waiting to use the service.

If you need to cancel an appointment for any reason, please contact us on 0191 287 6130
or email us at [email protected]

Due to the high demand for our service, if you are repeatedly unable to attend your appointments (or do not attend for three appointments in a row) and we do not hear from you in advance to cancel them, we will have to discharge you from our service. It is important to know that failure to attend your appointments, and being discharged from the service, may affect your treatment pathway, including any surgery we have referred you for.

What happens at my PIFU Appointment?

You will meet with the PIFU Clinician. This may not be someone you have met before.

If you think you might struggle with having to meet someone new, you should let the NRGDS know this when booking the appointment. Meeting with a familiar clinician cannot be guaranteed, and you may need to wait longer for an appointment but, wherever possible, the service will aim to honour this request.

This appointment will be booked for 30 to 60 minutes.

If your request cannot be sorted out in the appointment, the PIFU clinician will let you know that they need to speak to the wider team, and contact you as soon as an action plan has been made. This plan may include:

• Offering you another appointment to sort out your request with a member of the team best suited to help you.
• Informing you about what you need to do to sort out the request – such as speaking with your GP.
• Writing to another professional with the outcome of any conversation with your doctor, nurse, or endocrinologist in the service and what has changed with your prescription, or monitoring requirements.
• Adding you back onto the standard pathway, and ending PIFU until a time you can re-enter PIFU if that is right for you.

What happens once I have a date for my surgery?

The service which holds surgical referrals – GDNRSS – and your surgical team do not inform the NRGDS when surgery is booked.

Therefore, it is important that you contact the NRGDS as soon as possible when you are given a date so that we can book an appointment with your usual doctor or nurse after your surgery is complete.

This appointment usually takes place 3-6 months after surgery.

What other support is available, if I feel I am encountering a difficulty, but not a big enough difficulty that I need an appointment with the NRGDS?

It’s alright to contact us even if you’re not sure that, the support you need, or the question that you have, is enough to have an appointment with a clinician while you are on PIFU. We’re happy to try and direct you to the right place if having an appointment with us isn’t needed.

Additional methods of support can be found on our Resources and Support page.