Nottinghamshire Healthcare NHS Foundation Trust (NHC) was required by NHS England as an element of a Section 48 to implement a digital solution for Patient-Reported Outcome Measures (PROMs). PROMS are a national requirement and a gap was highlighted in a CQC inspection. Historically, the Trust's compliance with the purely paper-based Dialog+ PROMs was extremely low, averaging only around 1% - 2%. The project team was given a demanding time-sensitive deadline (October 2025) to implement PROMS and address the need to meet this national requirement for digital questionnaires as a priority. This initial requirement was planned and met within 3 months.

• The Workflow: The digital integration automates the delivery of Dialog+ questionnaires directly to the patient's PKB record at different times during the patient’s treatment.

• Clinician Benefit: By removing the need for staff to manually hand out, collect, and transcribe paper forms, the Trust has drastically reduced administrative overhead and both released and avoided unnecessary use of clinical time.  Data flows seamlessly into the clinical record, allowing clinicians to spend less time on data entry and more time on high-value patient interaction.  Clinicians have access to the responses received and can therefore tailor the conversations and care to better match the feedback received. 
• Patient Benefit: Patients are sent their PROMs at the beginning, middle and end of their treatment. They can complete the questionnaire in their own time, ensuring their voice is heard and their care is more personalised and accessible at each stage of their journey.  Questionnaires are sent to patients throughout their journey; before their first appointment, subsequent appointments and on discharge.  
• Trust Benefit: CQC compliance for completing this within the deadline, comfort in providing a solid, scalable digital PROMs solution and the ability to demonstrate that the views of patients are being considered when care is delivered.

The initial impact just on a small number of teams and in a very short timescale driven by necessity has been significant.  There has been some transition from paper to digital however, this was limited and the implementation of PROMS in just 3 months has led to a significant increase in patient engagement and compliance with national requirements:

• Completion Rate: The completion rate for the Dialog+ has increased 15-fold, rising from a historical low of 1% to 30% in the initial 3 months (raising to 34% by time of publication), for an initial 13 mental health teams.  

• Compliance: Providing the PROMs digitally was a key CQC requirement that the Trust had not achieved before using PKB.
• Patient experience: The active engagement and raised awareness for patients is to improve their experience and reduce the number of appointments missed. 
• Reputation: The Trust can demonstrate that patient outcome measures are being considered at each stage of care.  The results of questionnaires are fed automatically into the Patient Administration System (RiO PAS) for clinicians to access at the appointment.

To continue the clinical value of the digital platform and achieve the long-term goal of reaching over a 90% completion, the Trust’s next steps are focused on:

• Increase Registrations: Raising the current registration rate (approximately 40%) will directly increase the volume of completed responses.
• Improve Patient Engagement: Increasing patient engagement and awareness to help the team reach its target completion and return rates to impact reducing DNA rates from an average annual average for these initial teams of 27%, across all appointment types including Face to Face (resources). 
• Reduced waiting list (waiting time) due to the utilisation of available appointments and reduced DNA (lost time). 
• Increase Integrations: The inclusion of appointment letters and appointment details into their PKB record will further support engagement and the reduction of DNAs
• Improving Patient Outcomes: Clinical staff having patient related information readily available and using the data to better improve clinical outcomes from the service users in the Trust. 
• Improved patient (and relative) experience by publicising and promoting the availability and value of PROMS for patient driven feedback.  Patients will be encouraged to complete questionnaires on arrival if they have not had a chance or been aware before that time. 
• Waiting list validation and management for a team under significant pressure from demand, identifying the need, with the aim of reducing waits for assessment or first appointment.  
• Continuing the monitor uptake and responses and to engage with patient representative groups for awareness of PKB PROMS.