Providing Equitable Care to All Patients

SJT Textbook: Providing Equitable Care to All Patients

Providing Equitable Care MSRA

This guide covers the proactive duty of Providing Equitable Care MSRA scenarios. In the Professional Dilemmas paper, you must demonstrate that treating everyone exactly the same is often unfair; true fairness requires adapting the service to the patient.

🎥 Video Lesson (YouTube)

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🎯 THE CORE PRINCIPLE

Providing equitable care means tailoring access, information and follow-up so that people with different needs can achieve fair outcomes. Patients may face barriers around language, disability, culture, health literacy, digital access, transport, finances or caring responsibilities. Treating everyone identically often leaves those barriers in place; equity requires active adjustment.

In the SJT, strong answers show you looking for barriers rather than waiting for patients to mention them, then putting reasonable adjustments in place without delay. That includes arranging professional interpreters, accessible formats, longer or flexible appointments, and appropriate support people where consent allows, while still prioritising clinical urgency.

High-scoring options also show that you use shared decision-making, check understanding with teach-back, and coordinate with primary care and community services. You record communication needs and adjustments clearly (e.g. AIS flags), so that future clinicians do not repeat unsafe shortcuts. Low-scoring answers rely on standard leaflets, family interpreters, or “online-only” access without an alternative route.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Ask proactively about language, communication, mobility, sensory and social barriers before important decisions.
2. Arrange a professional interpreter or communication support (e.g. BSL, Easy Read, large print) rather than relying on relatives.
3. Adjust time, environment and process (longer slot, quieter room, wheelchair access, flexible scheduling) where needed for safety.
4. Use shared decision-making tools and teach-back to confirm that the patient has understood the options and risks.
5. Involve carers, advocates or support workers appropriately, with the patient’s consent and respecting confidentiality.
6. Coordinate with GP, community teams, learning disability or mental health services to support follow-up and adherence.
7. Record communication needs and adjustments clearly in the notes and as AIS-visible flags for the wider team.
8. Identify when “equal” processes (e.g. digital-only booking) are creating inequity and raise service-level improvements.
9. Prioritise clinical need, not convenience or routine, when deciding whether to extend time or rebook.
10. Safety-net explicitly, explaining what to look out for and how to seek help, and ensure the advice is accessible to that patient.

Trap options equate “sameness” with fairness, rely on family members to interpret, ignore urgent communication needs, or accept exclusionary systems rather than making reasonable, timely adjustments.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I will arrange a professional interpreter and Easy Read information now, and add an AIS flag so future appointments meet your needs.”
* “Can you tell me in your own words what the plan is and when you would seek help, so I can be sure I have explained it clearly?”
* “Because of the barriers you have described, I am extending this slot and coordinating with your GP and community team for follow-up.”
* “Our current process is excluding some patients; I will raise this with the service lead and suggest a telephone and in-person alternative.”

E = Explore barriers
Q = Quality information
U = Understand (teach-back)
A = Adjust time/place/process
L = Link with community and primary care
I = Identify and flag communication needs
S = Safety-net
E = Evaluate and refine next time

📋 QUICK FAQ

Does equity mean giving some patients more time than others?
Yes, when clinically justified. Equity is about tailoring support so that understanding and access are safe and fair. Some patients will need longer or different formats for information to reach the same standard of safety.

Can I use family members to interpret in urgent situations?
You should prioritise professional interpreters whenever possible. In rare emergencies, a family member might be used briefly while professional support is arranged, but this should be documented and replaced with formal interpreting as soon as possible.

Is the Accessible Information Standard (AIS) optional?
No. AIS sets mandatory requirements for NHS organisations and publicly funded adult social care to identify, record, flag, meet and review communication needs, including interpreting and alternative formats.

What if a patient repeatedly misses appointments?
Do not label this as “non-compliance” without exploring barriers. Consider transport, caring duties, health literacy, mental health and digital access. Adjust appointment type, timing or support and document what you have done.

How do I balance service pressure with longer appointments?
Patient safety and valid consent come first. Where extra time is needed to reach a safe decision, you should extend the slot or rebook with appropriate support, and raise capacity issues with service leads.

Is “treating everyone the same” ever the correct answer?
You must treat everyone with respect and according to clinical need, but processes often need to be different to achieve equitable outcomes. In SJT terms, “the same for everyone” without adjustments is usually a trap.

📚 GMC ANCHOR POINTS

• Treat patients fairly and without discrimination, while responding to their individual needs.
• Communicate effectively, using appropriate resources to meet language and communication needs.
• Work in partnership with patients, supporting informed decisions that reflect their preferences and circumstances.
• Raise and act on concerns about systems that create barriers to safe care or worsen inequalities.
• Keep clear, accurate and timely records, including communication needs and agreed adjustments.

💡 MINI PRACTICE SCENARIO

A man with a learning disability attends clinic for discussion about elective surgery. He nods throughout but cannot explain the procedure or risks when you ask him. The appointment is nearly over and the clinic is running late. There is no Easy Read information or specialist support worker arranged.

Best action: Extend the consultation or arrange an urgent follow-up with Easy Read information and, if available, learning disability support; use simple language and teach-back, and record his communication needs and adjustments as AIS flags.
Why: Valid consent requires real understanding. Adjusting time, communication tools and support to his needs provides equitable care and meets AIS, GMC and NICE shared decision-making principles; rushing ahead on the basis of nodding would be unsafe.

🎯 KEY TAKEAWAYS

✓ Equity means tailoring processes to remove barriers, not giving everyone identical care.
✓ Professional interpreters and accessible formats are core patient-safety tools, not optional extras.
✓ Teach-back is a powerful way to confirm that information has been understood.
✓ Communication needs and adjustments must be recorded and flagged so others can act on them.
✓ Digital or rigid processes that block access should be challenged and improved.
✓ Safe consent and follow-up rely on realistic planning around the patient’s actual circumstances.

🔗 RELATED TOPICS

* → Avoiding Discrimination
* → Respecting Cultural and Religious Beliefs
* → Addressing Health Inequalities
* → Accessible Information Standard and Communication Needs
* → Shared Decision Making

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

You are in pre-assessment clinic. A 54-year-old woman with poorly controlled diabetes and limited English attends with her adult daughter. She has been given a dense English leaflet about planned surgery. She smiles and nods but cannot explain the procedure or risks when asked. No interpreter is booked. The list is due next week.

Options:
A. Proceed with the discussion using the leaflet and gestures, documenting that she nodded in agreement.
B. Ask the daughter to interpret the full consent discussion so you can complete the form today.
C. Rearrange an urgent appointment with a professional interpreter, provide translated or Easy Read information, use teach-back, and document AIS flags.
D. Explain that there is no time to rebook and that surgery will be cancelled if she does not sign today.
E. Request a longer follow-up slot with an interpreter and flag the need in the notes so future staff know to arrange this.
F. Record that consent was “difficult” but sign on the basis of best interests, as this is more efficient.
G. Explore her broader barriers (caring duties, travel, literacy) and involve pre-operative nurses to support follow-up planning.
H. Do nothing different; all patients receive the same leaflet and time slot to keep things “fair”.

Example SJT — Rank 5 (best → worst)

A GP practice has moved to online-only appointment booking. A 78-year-old man with visual impairment and no internet access has missed multiple reviews for heart failure because he cannot use the system. Reception staff say, “His grandson should book for him; everyone else manages.”

Options:
A. Arrange a telephone or in-person booking pathway for him immediately, explain this to the patient, record his needs and raise the digital barrier at the next practice meeting.
B. Book today’s appointment manually as a one-off favour but make no changes to the system or records.
C. Advise him to attend the surgery in person at 8 am to queue for urgent slots if he cannot book online.
D. Suggest he asks family or neighbours to use the online system on his behalf.
E. Do nothing; the practice policy is online booking only.