GIRFT has shared new guidance supporting trusts to standardise their protocols for follow-up outpatient appointments, helping to reduce unnecessary attendances and free up capacity for new and urgent patients.
Follow-up appointments represent 54% of NHS outpatient activity in England. GIRFT’s work has shown that many of these follow-ups are of limited clinical value, using clinical time which could be spent on seeing new patients more quickly, and reducing waiting lists.
GIRFT’s new guidance, which draws on the experience of trusts taking part in the GIRFT Further Faster Follow Up Collaborative, includes example follow-up protocols from six high-volume specialties – ENT, gastroenterology, gynaecology, ophthalmology, spinal surgery and trauma and orthopaedics. These include clear criteria for when routine follow-up is clinically required, the diagnostics required prior to review, opportunities for patient-initiated follow-up (PIFU) and safety-netting standards.
These protocols have been used in NHS trusts and shown to be effective in ensuring that patients receive the right care, in the right setting, at the right time. This in turn can improve the use of outpatient capacity and reduce unnecessary appointments.
Professor Tim Briggs, GIRFT programme lead and NHS England National Director for Clinical Improvement, Elective Recovery and UEC, said:
“Given the continued pressures on outpatient services, and the long waiting times for patients to be seen, it is crucial that we maximise every opportunity to utilise our clinical time as effectively as we can.
The initial phase was to standardise clinic templates within specialties at trust level and we are now realising the benefits of this. Now we need to also focus on transforming follow-up pathways; we have followed up too many patients in the past and this must now be a high priority if we are to address long-standing variation and improve access and experience for patients.
We ask that all trusts review and implement these pathways as soon as possible. Early adoption will support improvements in patient experience, reductions in DNAs and increased outpatient productivity, while contributing to national consistency.”
The guidance outlines the optimal outpatient follow-up model, to include:
- Risk stratification: protocols and safety-net criteria specific to the condition and pathway, with stable patients discharged or moved to PIFU and high-risk groups retained with condition-specific surveillance.
- PIFU: Empowering patients to decide whether they need and want to be seen again.
- Digital by default: Using patient portals, virtual reviews and self-monitoring tools, with equity safeguards in place.
- Remote monitoring: Preventing the need for some patients to attend for regular tests.
Case studies from successful trusts are also included, along with a checklist for operationalising standardised follow up pathways and specialty specific guidance to support local teams in initiating review and redesign of their follow-up pathways.
The new guidance is the second module in GIRFT’s series of outpatient operational guides covering the skills needed to effectively manage outpatient departments. The first module – Standardising clinic templates – was released in 2025 and early adopter sites have already reported a 15–30% increase in clinic capacity through standardisation alone.
Other guides are planned on pre-referral optimisation, booking and scheduling, appointment delivery, environment, the use of digital tools and technology, and clinical pathways.
