Diabetes Patient-Initiated Follow-up (PIFU)


This leaflet provides information for patients who have attended an out-patient clinic at King George or Queen’s hospitals and have been offered a ”patient-initiated follow-up” appointment.  It explains what this is, how it works, and provides you with the information you need to contact our service to arrange a follow-up appointment, if you need one. We hope that it helps you to feel in control of your own care.

What is a Patient Initiated Follow-Up appointment?

Patient initiated follow-up (PIFU for short) allows you to arrange follow-up appointments as and when you need them. This puts you in control of your hospital follow-up and provides you with direct access to guidance, when you most need it.

How does PIFU work?

If PIFU is suitable for you, your clinician will discuss your condition with you and add your name to a PIFU list. Instead of being given a routine follow-up clinic appointment, you will be able to contact the service directly to arrange a follow-up appointment, if you feel you need it. Your clinician will tell you how long you will stay on the PIFU list, which is determined by your clinical condition.

If you do not need to see the doctor or nurse about your condition within the timeframe discussed at your last appointment, you will be discharged back to your GP, who will re-refer you if you need to be seen again in the future.

Why are we introducing this new type of follow-up appointment?

We are introducing this new type of follow-up because it offers a number of benefits. These include:

  • PIFU puts you in control of your own out-patient follow up.
  • Appointments can be made based on your needs rather than at routine intervals, which often do not add value to your care.
  • If you experience a flare-up in symptoms, you will be able to receive guidance when you need it.
  • Saving patients time and money they spend attending non-essential appointments. The number of people making these journeys will be greatly reduced and we hope it will improve your experience.
  • Freeing up appointments for people who need to be seen, means we can reduce the waiting times for them to be seen more quickly.
  • It will also help us to cut down our carbon footprint by reducing the number of unnecessary journeys to our hospitals.

What do I need to do?

If you experience any problems with your condition, have complications following treatment or your symptoms return or worsen, please contact the Diabetes PIFU team to arrange an outpatient appointment on 01708 435000 ext. 2176 for Queen’s Hospital and ext. 8056 for King George Hospital between 9.00am and 5.00pm, or alternatively email us at bhrut.pifudiabetes@nhs.net

When should I not use PIFU?

You should not use PIFU for medical problems that are not related to the Diabetes specialty and the condition you were originally referred to us for. For other conditions, your GP remains your first point of contact.

Frequently asked questions

How long is the visit likely to take (procedure and waiting time)?

How long you will be in the endoscopy unit will depend on the procedure you have, if you have a sedative injection, and how you feel after your procedure. Patients who have a sedative are kept in the department longer so we can monitor them until they are fully awake. Typically a patient will be with us for 2-3 hours. Occasionally endoscopy lists run late as procedures sometimes take longer than we expect or we have unavoidable delays. The nurses in the endoscopy will inform you of any delays.

Will the procedure hurt or be uncomfortable?

In the endoscopy we try to make you as comfortable as possible during your procedure. We often use sedation, Entonox (gas and air) and local anaesthetic or combinations of these drugs. It is our aim to make you as comfortable as possible during your procedure, however slight discomfort can be common. During colonoscopy or flexible sigmoidoscopy a feeling of trapped wind is common and in investigations of the stomach a bloated feeling and burping is very common. You can find more about pain relief options on the menu page.

Will I be able to stop the procedure at any point?

Yes, you can stop the procedure at any time. 

There will be a nurse with you at all times so you can tell them, the endoscopist will be listening to what you say too. During gastroscopy it’s difficult to speak so we tell patients to raise their hand in the air as a sign that they need our attention/ want the test to stop. 

What happens if I don’t take the bowel preparation properly?

It is very important that you follow the bowel preparation instructions carefully. If you don't not follow the instructions the bowel lining may not be clean and the endoscopist will not be able to see any abnormalities that are there. If your bowel is not clean it can mean that you have to repeat the bowel preparation again.

If you have any questions, problems or concerns with your bowel preparation, please call the number on your letter and they will be able to give you some advice. 

Who will be with me during the procedure?

During the procedure you will have allocated to you a nurse whose role is to take care of you. The nurse will monitor your observations and if also check if you are experiencing any pain throughout your procedure. The nurse will also support and guide you through your procedure. If you have any concerns let your nurse know so they can help you.

What are the effects of the sedatives - what can I, and can’t I, do after the procedure?

Many people expect that the sedation will "put them to sleep" but this is not the case. Some people feel a little drowsy but you should expect to feel relaxed and calm but awake. Some people do feel a little sleepy but not everyone. The sedative can give you some amnesia so you may find that you forget some or all of your procedure. It can also make you a little unsteady on your feet. For these reasons we ask that you have someone to collect you from the endoscopy department, go home in a car/ taxi (not public transport/train), rest at home for 24hrs (no work) and do not drive, operate machinery or sign important documents.

Can I ask staff for help if I am worried when I arrive at the unit?

The staff in the endoscopy unit are here to help you any time during your stay in the endoscopy unit.

When you arrive you will be checked in by our reception staff and then seen by one of our assessment nurses who will take your details, discuss your procedure with you and get you ready. If you have any worries you can speak to the nurse at this point.

When will I get my results?

After your procedure the endoscopist will let you know the outcome of your procedure. It is not always possible to know exactly what the results are especially if biopsies are taken. The endoscopist will let you know if they have seen anything but you may need to wait until biopsy results are back to get the further information about exactly what is happening.

The doctor who referred you will go through the results of the endoscopy and any biopsies in more detail when they see you in clinic/ GP surgery.

What should I do if: 

  • I need transport.
    transport is only booked for patients who are eligible for this. If you have had transport before please ring the administration department who will book transport for you. If you have not had transport before you will need to see your GP to organise this. They will then register you as eligible for transport so we can book it if you need it for future appointments.


  •  I am confused about the bowel preparation, I don't understand what to do.
    Please contact the pre assessment nurses or the admissions team with any concerns about the bowel preparation and they will be able to give you some advice. 


  • I feel unwell after I have taken the 1st sachet of bowel preparation.
    Please contact the pre assessment nurses or the admissions team and they will be able to give you some advice.


  •  I need to take my tablets and I'm fasting.
    You should take your tablets as normal unless you have specifically been told not to for example blood thinning tablets. If you are fasting for a morning gastroscopy appointment please take essential tablets (blood pressure and heart medication) early with a sip of water. For afternoon appointments again plan to take medication early with a sip of water.


  •  I'm taking blood thinning tablets.
    You should have received information in your letter about what to do in regards to your blood thinning tablets. If you have no instructions you should call the admissions team for advice.


  •  I don't want to have the procedure.
    If you don't want to have your procedure the decision entirely yours. We would ask that you call the admissions team so that we can give the appointment to someone else. 


  • Who should I contact about any concerns following the procedure/discharge?
    If you have any immediate concerns or questions when you leave the endoscopy unit you should contact the endoscopy unit where you had the procedure. The number can be found on your discharge advice sheet. You would have also been given some instruction about what to do if you are feeling unwell after your procedure. If you have any concerns about the care you received whilst in the endoscopy department you should call the endoscopy department manager who will address your concerns directly, or you may contact our Patient Liaison service (PALS). 

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