Using Patient-Reported Outcome and Experience Measures (PROMs & PREMs) in NHS-Commissioned Community Services

Within NHS Outcomes & Impact measurement and broader NHS community service models and pathways, patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are becoming central to commissioner conversations. NHS commissioners increasingly expect providers to evidence not only clinical or system performance, but also how people experience care and whether they perceive meaningful improvement. Used well, PROMs and PREMs strengthen governance, demonstrate person-centred practice and provide defensible quality assurance. Used poorly, they become tokenistic surveys disconnected from operational reality.

Clinical and operational leads can use the NHS community pathways and system integration hub to review how governance, partnerships and population health priorities connect.

Why PROMs and PREMs Matter in Commissioning

PROMs measure change in a person’s health status or functional ability from their own perspective. PREMs measure their experience of care delivery. Commissioners use both to assess whether services are responsive, respectful and effective.

For community and adult services, PROMs and PREMs are particularly important because:

• Much impact is functional or psychosocial rather than purely clinical.
• Services often aim to improve independence and confidence.
• Experience directly affects engagement, adherence and safety.

Operational Example 1: Reablement Service Using Functional PROMs

Context: A six-week reablement service supporting people after hospital discharge.

Support approach: Goal-focused intervention aimed at restoring independence in activities of daily living.

Day-to-day delivery detail: At assessment, staff complete a structured baseline functional questionnaire with the person. Goals are agreed and recorded in the care plan. At week three and week six, the same measure is repeated. Supervisors review outcome trends during weekly team meetings, and a sample of assessments is audited monthly for accuracy and consistency.

How effectiveness is evidenced: Change in functional scores between baseline and discharge, percentage of goals achieved, and proportion of people requiring no ongoing package. Data is reported quarterly to commissioners alongside qualitative feedback describing how independence was regained.

This evidences real-world change rather than simply reporting “hours delivered.”

Operational Example 2: Community Mental Health Support and Recovery PREMs

Context: Community support for individuals with severe and enduring mental illness.

Support approach: Recovery-focused planning and structured risk management.

Day-to-day delivery detail: Staff gather PREMs at review points, asking about involvement in decision-making, clarity of crisis plans and perceived respect. Feedback is anonymised and collated monthly. Themes are discussed in clinical governance meetings and supervision sessions.

How effectiveness is evidenced: Improvement in reported involvement in care planning, reduction in complaints related to communication, and correlation between positive experience scores and reduced crisis presentations.

Experience data is linked directly to quality improvement actions, such as revising information leaflets or strengthening handover protocols.

Operational Example 3: Long-Term Condition Pathway and Self-Management Confidence

Context: Community respiratory pathway supporting people with COPD.

Support approach: Education, inhaler technique review and early deterioration planning.

Day-to-day delivery detail: At initial contact, staff assess self-management confidence using a structured scale. This is repeated at discharge. Data is entered into the central performance dashboard and reviewed in monthly contract meetings.

How effectiveness is evidenced: Increase in self-reported confidence scores, combined with reduced unplanned GP attendances and improved inhaler adherence rates.

This triangulation ensures that subjective feedback is balanced with objective indicators.

Commissioner Expectation

Commissioner expectation: PROMs and PREMs must be proportionate, validated where possible, and consistently applied. Commissioners expect clarity around response rates, data collection methods and how feedback informs service redesign. Experience data should not be presented in isolation but linked to measurable improvement actions.

Regulator / Inspector Expectation

Regulator expectation (CQC): Inspectors expect providers to demonstrate that people’s voices shape service delivery. PROMs and PREMs should evidence responsiveness, involvement in care planning, and safe management of concerns. Where experience data highlights dissatisfaction or safeguarding risks, there must be clear evidence of follow-up and governance oversight.

Governance and Data Integrity

Robust use of PROMs and PREMs requires governance discipline. Effective providers:

• Define clear data collection points.
• Train staff to avoid leading questions or inconsistent scoring.
• Monitor response rates and demographic variation.
• Review outliers and negative trends through governance committees.

Experience data should inform staff supervision, quality improvement plans and board-level reporting. Where patterns suggest inequalities or access barriers, services must demonstrate corrective action.

Services designing PROMs, PREMs or wider impact measures should connect them back to core NHS outcomes measurement principles.

Avoiding Tokenism

Common pitfalls include low response rates, overly complex questionnaires, or collecting data that is never reviewed. The most mature organisations ensure that PROMs and PREMs are integrated into everyday practice and directly linked to improvement cycles.

When used proportionately and transparently, patient-reported measures strengthen credibility. They show commissioners and regulators that services are not only active and clinically safe, but genuinely improving people’s lives and experiences.

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