Sir, we would like to congratulate Scambler and Asimakopoulou on the recent article A model of patient-centred care (PCC)1 which highlights the importance and relevance of PCC within dentistry. Formulation of a model of PCC is an important step in the process of developing a tool that can be reliably used to assess patient experience, and this is particularly pertinent in view of the direction of travel of the proposed dental contract reforms.

We are currently conducting health services research on PCC from a patient's perspective, predominately focusing on the decision-making process, and we would agree that shared decision-making (SDM) is a fundamental aspect of PCC, but that other aspects need to be considered. Provision of information is repeatedly highlighted as a key component and our work has identified the importance of avoiding a one-directional view of this, with the clinician as the provider and the patient the recipient. It is important to acknowledge the role which the patient plays in 'providing' information such as symptoms, history, concerns, attitudes, values and beliefs in order for a clinician to make a diagnosis and formulate a treatment plan which can be used to support SDM. For this, the clinician must have the skills to communicate, the time to listen and a desire to deliver PCC. The prevailing healthcare system has a profound influence on the ability to deliver PCC and the challenges in achieving this under the present UDA-centred contract need to be recognised.

The current Dental Quality Outcomes Framework (DQOF)2 predominately uses patient satisfaction indicators as a marker of 'patient experience'. This would seem entirely inappropriate as it is widely recognised that patient satisfaction is a poor and unreliable indicator of quality.3,4 The NHS Patient Experience Framework5 is closely aligned to the Picker Principles of PCC and it is important that any future iteration of the DQOF attempts to measure aspects of PCC rather than simply choosing to measure what is easy, over what is relevant.

Future work needs to inform the development of a reliable tool to measure PCC within general dental practice as it cannot be assumed to have been achieved simply by measuring the final outcome, without consideration to the process. Any tool designed to measure PCC needs to be able to assess the delivery of the 'foundational components',1 and this means it must involve more than just an assessment of shared decision making or patient satisfaction as an endpoint.