Background Patient-initiated follow-up within personalised stratified follow-up replaces some routine appointments with supported self-management and a route back to specialist care or relevant support when concerns arise. It may become inequitable when re-access depends on unclear contact routes, repeated triage, and delayed responses. We examined how people got back into care or support in breast cancer pathways in England and derived a candidate assisted-access specification for fairer re-access.Methods We conducted two rounds of online focus groups with people with lived experience of breast cancer and family carers (n = 16). Using a realist-informed qualitative design and documentary analysis, we analysed re-access episodes from first concern to the reported outcome of that help-seeking attempt. We then analysed how pathway arrangements interacted with participants’ resources to shape what happened next.Results Participants described re-access not as a single act of “getting back in touch” but as repeated work: interpreting information, finding a route, waiting, chasing, and deciding whether it was safe to persist. Re-access was made harder by friction and depletion. Patients and carers were often left to monitor progress, chase responses, and coordinate the next step. Capacity to persist was uneven, and whether concerns were voiced depended partly on interactional safety. Opaque routing, voicemail loops, untracked requests, and inaccessible communication shifted learning, compliance, logistical, and psychological costs onto patients and family supporters. Timely reconnection often depended on time, confidence, language, money, or informal support. From participants’ accounts, stress-tested in round two and then cross-checked against current policy and pathway guidance, we derived a candidate assisted-access specification centred on a multi-channel front door, named triage ownership, tracking to closure, a second-look route, recognition of family supporters, and assisted navigation and outreach.Conclusions Fair re-access depended not only on clinical need but on whether services provided workable route-back infrastructure for people who were unwell, fatigued, or managing unequal resources. Patient-initiated models may widen inequalities when administrative and safety work are shifted onto patients without compensatory design. The candidate assisted-access specification offers a bounded basis for local adaptation and prospective evaluation rather than a validated universal standard.