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J. Davies-Slowik V. Firmstone J. Frame British Dental Journal 2011; 210: E6

Editor's summary

This paper highlights the benefits that can follow when a sensible solution to an identified need is recommended and that recommendation is acted upon and subsequently evaluated. The government funding and training initially provided for Retaining and Returning Advisers (RRAs) in the first three years following their introduction to the postgraduate dental deaneries undoubtedly contributed hugely to their successful integration into the deanery teams. That the RRA role was truly needed can be seen in the fact that all the deaneries retained their RRAs when central government funding ceased after three years and responsibility for the financial arrangements devolved to local deanery budgets.

The results of this study show that RRAs have proved to be flexible and have adapted well to changing circumstances and local needs. From an initial focus on dentists returning to practice following a career break, after five years RRAs' roles had expanded to include groups such as dentists who trained overseas, those seeking equivalence to vocational training, dental care professionals (DCPs) and poorly performing dentists. This process of role expansion appears to have evolved naturally as policies and workforce issues have changed over time – another indication that the introduction of RRAs was based on a correctly identified need.

As the authors point out, this history of flexibility puts RRAs in a strong position to respond to future changes in workforce, policy and educational priorities. In her commentary on this paper (right), Dame Margaret Seward, the author of the original report recommending the introduction of RRAs, identifies the next year or two as an ideal opportunity to once again revisit the contribution of RRAs to postgraduate dental education. It is clear that RRAs today do much more than simply helping to 'retain and return', and with the introduction of revalidation, the extended roles of DCPs and the prospect of yet another new commissioning structure for primary care dentistry on the horizon, they have the potential to play a key role in postgraduate dental education for theforseeable future.

The full paper can be accessed from the BDJ website ( http://www.bdj.co.uk ), under 'Research' in the table of contents for Volume 210 issue 5.

Rowena Milan Managing Editor

Author questions and answers

1. Why did you undertake this research?

Aimed at reviewing the role of the Retaining and Returning Advisers (RRAs), this research was undertaken to investigate the overall success of the RRA initiative and consider its likely future. The study was conducted five years on from the launch of RRA posts in all English postgraduate dental deaneries, and four years after the authors evaluated the initiative for the Department of Health.

In the intervening years, considerable change had taken place for RRAs: the Department of Health's central funding for the role had finished, a new dental contract had been implemented, bringing with it new responsibilities for PCTs in dental commissioning and quality assurance, and concerns about the supply of the dental workforce had abated. Such change generated our research questions: how had these changes affected the education and support activities provided by RRAs? Had the RRA role been a success? And what were their future priorities?

2. What would you like to do next in this area to follow on from this work?

Our priority for future research will be to focus on one specific target group for the RRAs: poor performers, ie dental professionals who have been identified as underperforming in their workplace, and who absorb considerable educational resources from postgraduate deaneries, often over many months. Our research would aim to understand 'what works' and 'what doesn't' for underperforming practitioners, in the hope of better understanding how deaneries can make timely and effective educational intervention.

Commentary

Fortunately one of the recommendations contained in the report Better opportunities for women dentists advised not only on appointing a Retaining and Returning Adviser (RRA) for one day each week based in each postgraduate deanery in England but also stipulated that an evaluation of their effectiveness should be planned in advance using agreed protocols to achieve consistency across deaneries. In implementing the recommendation, the Department of Health provided funding for the first three years and also organised training sessions for the advisers, an invaluable support mechanism for the new member of the postgraduate deanery team.

The authors in this paper review the RRAs' activities over the five-year period from the inception of the initiative in 2002. After the first 12 months of operation a formative evaluation was completed and I believe the outcome of the research was enhanced by the researchers, who engaged with the RRAs at the outset to explain the methodology of the study and encourage enthusiasm for the project. The definitive review of the first five years reported here took place in 2006/07 using a three-phase research design: semi-structured interviews with all RRAs, an electronic survey with all 12 postgraduate dental deans and analysis of the resulting qualitative data.

The results clearly show that the role of the RRA was not confined to the original concept of dealing with dentists on career breaks and return to work initiatives, but had evolved to include poor performers, those seeking VT equivalence, dental care professionals and overseas dentists. Reassuringly, despite the intervening changes in strategic policy, the RRAs, most of whom had been in post since inception, had carved out a unique dental educator role in each deanery and it became clear that if they had not existed they would have to have been invented.

So to the future. Diversity in their job will continue and they are well placed to assist with the challenge of revalidation. In 2011/2012 it will be 10 years since the introduction of the RRA. I believe it is an ideal opportunity to revisit their educational contribution to the expanding dental workforce and so ensure that continuity of data is not lost.