Addressing NHS Waiting Times Through Patient-Initiated Pathways

February 16, 2024 • Reading time 3 minutes

As of November 2023, the NHS faced a significant challenge with approximately 7.61 million patients on waiting lists for various treatments. This figure underscores a critical issue within the healthcare system, highlighting both the clinical risks associated with delayed follow-ups and the operational strains on healthcare resources.

Addressing Waiting List Challenges with PIFU

The concept of Patient Initiated Follow-Up (PIFU) has emerged as a strategic response to these challenges. By allowing patients to determine the necessity and timing of their follow-up appointments, PIFU aims to enhance patient safety, optimise appointment scheduling, and reduce unnecessary follow-up engagements, thereby potentially decreasing waiting list volumes.

Despite the theoretical benefits of PIFU, there remains a lack of empirical evidence supporting its efficacy in practice. This, along with the ever-present challenges of changing existing pathways, means that many Trusts will miss the modest target of moving 5% of outpatient attendances to PIFU pathways, that NHS England set for March 2023 as part of the Elective Recovery Strategy.

The Role of DrDoctor and Key Findings: up to £167 million in System-wide Savings

In this context, DrDoctor, which oversees around 20% of NHS outpatient booking activities, including PIFU services, has played an important role. Through its operations across multiple Trusts, DrDoctor has gathered extensive data that, when analysed alongside Trust-specific data, offers insights into the potential health economic benefits of PIFU to inform increased usage and improvement of the service.

Edge Health was commissioned by DrDoctor to combine learning from this data as well as from interviews with clinical and operational staff involved in implementation at two large NHS Trusts to start evaluating this service delivery model. The report sets out the findings from data analysis, literature review and operational and clinical engagement into the potential real-world benefits, and best practice implementation of PIFU.

Key findings suggest that achieving the national target of a 5% PIFU pathway adoption rate could result in the saving of approximately 1,393,154 outpatient follow-up appointments annually, leading to an estimated system-wide saving of at least £167 million, based on 2020/21 figures.

Implementation Insights and Potential Impacts

Our report also provides details on how to effectively implement digital PIFU within Trusts, based on conversations with implementation teams. This highlights the types of specialties proven to be most successful to date, the conditions for the successful delivery of the roll-out of digital PIFU, key challenges services faced with implementation and what learnings they would give other Trusts at the start of their implementation.

The report also highlights the benefits to patients and the NHS of another form of patient-initiated pathway, Patient Initiated New Appointment (PINA). This is where patients referred to secondary care for an appointment are given control over whether they still require the appointment.

This report provides invaluable, real-world evidence highlighting the extensive value of implementing PINA and PIFU at scale within the NHS. It underscores the transformative role digital tools have in simplifying processes, modernising patient care and driving efficiency of system operations. We’re pleased to have worked with EDGE Health in producing this report and are excited about the wider impact this collaboration will have on the healthcare sector in reducing unnecessary follow-up appointments and tackling the backlog.

Tom Whicher, CEO of DrDoctor

From a waiting list perspective, PINA can help reduce the number of unnecessary first appointments at a Trust, in a similar way to PIFU. It is estimated that between 3-15% of patients on the waiting list do not need an outpatient appointment by the time they get contacted. By removing eligible patients who do not actually need a first outpatient appointment and are appropriate for PINA, our report found that the waiting list significantly decreases. This could mean a reduction in the waitlist by between 228,000 and 1,141,500 patients.

Therefore, the findings from our report can be used by Trusts to understand the potential of patient-initiated appointments (both PINA and PIFU) at their Trust and help them meet NHS England targets, while also driving down waiting list size and improving patient experiences.

Read Our Full Report Below:


Edge Health are a specialist UK healthcare analytics consultancy that use data and insights to improve the delivery of health and care services, so that better outcomes can be delivered more efficiently.