Resource Allocation & Fairness

SJT Textbook: Resource Allocation & Fairness

Resource Allocation MSRA

This guide covers the ethical challenge of Resource Allocation MSRA scenarios. In the Professional Dilemmas paper, you are tested on your ability to distribute scarce healthcare resources—beds, scans, and time—based on clinical need rather than social pressure.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Resource allocation in the NHS is about making defensible, patient-centred decisions when time, staff, beds, tests or appointments are limited. Safe doctors use explicit criteria such as clinical urgency, potential benefit, and risk from delay rather than first-come-first-served or who shouts loudest. They remain alert to health inequalities and avoid unlawful discrimination.

The NHS has legal duties around equality and health inequalities, and strategic frameworks such as Core20PLUS5 to target the most deprived and marginalised groups. Within this context, you must balance individual need with population benefit, explaining decisions and safety-netting those who must wait. Where clinically appropriate options are equivalent, you may choose the lower-burden or more sustainable pathway.

In the MSRA SJT, high-scoring options show you defining clear prioritisation criteria, applying them consistently, considering barriers to access (for example language or disability), communicating expected timeframes honestly, escalating when capacity becomes unsafe, and documenting your reasoning. Convenience, seniority or pressure from relatives should never trump fairness, safety and equity.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Define explicit prioritisation criteria: clinical urgency, expected benefit, and risk if delayed, applied consistently across patients.
2. Identify and mitigate barriers linked to inequalities (for example deprivation, language, disability), using interpreters and reasonable adjustments.
3. Communicate clearly with patients and families about waiting times, prioritisation logic, and what to do if they deteriorate.
4. Safety-net those who must wait by providing red-flag advice, alternative pathways, or planned reviews.
5. Escalate early to senior clinicians, site/bed managers or operational leads when capacity is no longer safe.
6. Resist inappropriate queue-jumping requests based on status, seniority or complaint threat; explain and stick to criteria.
7. Make good use of resources by avoiding unnecessary duplication and low-yield tests while protecting safety.
8. When options are clinically equivalent, consider lower-burden or more sustainable (for example lower carbon) options and document why.
9. Record allocation decisions, criteria used, any inequalities considerations, who was informed, and the plan for review.

Trap answers usually reflect convenience, hierarchy, pressure or fear of complaints instead of transparent, criteria-based decision-making grounded in clinical need and equity.

💬 MODEL PHRASES (Use These in SJT Logic)

* “Capacity is now unsafe; I am escalating to the duty consultant and site manager while we safety-net the patients who are waiting.”
* “Let us check whether language, disability or transport are making it harder for this group to access care, and adjust our approach so it is fair.”
* “I cannot move your relative ahead of more urgent cases, but I can explain the situation, give clear timeframes, and review if they deteriorate.”
* “I will record how we have prioritised these tests today, including any inequality risks and who we discussed this with.”

F = Focus on clinical need, benefit and risk from delay
A = Address inequalities and access barriers
I = Inform patients about timeframes and safety-netting
R = Raise and escalate capacity concerns early

E = Evidence your reasoning in the notes and establish review points

📋 QUICK FAQ

Is “first come, first served” ever appropriate for clinical queues?
Generally no. It may be used within a clinically similar group, but overall you should prioritise by urgency, benefit and harm from delay, then explain and record your reasoning.

What if a senior asks you to prioritise their patient outside the agreed criteria?
Acknowledge their concern, restate the agreed clinical criteria, and explain why other patients currently have greater clinical need. Offer to review the list together or escalate to the duty consultant or site manager if needed.

How do I factor in inequalities fairly?
Look for barriers such as language, disability, digital exclusion, homelessness or deprivation. Use interpreters, accessible information, reasonable adjustments and targeted follow-up so that high-need patients are not left behind.

Can sustainability influence resource decisions?
Yes, but only where clinical benefit and safety are equivalent. In that situation you may favour lower-burden or more sustainable options (for example fewer unnecessary journeys or tests), and document why.

What should I document after a difficult allocation decision?
Record the clinical criteria used, key options considered, any inequalities or safeguarding factors, who you involved, the final decision, what you told patients or families, and any escalation or review triggers.

📚 GMC ANCHOR POINTS

• Treat patients fairly and with respect, without unlawful discrimination (GMC Good medical practice 2024).
• Make good use of the resources available, taking account of sustainability while not compromising patient care.
• Be open and honest about decisions, including limits to what can be provided, and communicate clearly.
• Recognise and act on concerns about safety, including excessive workload or unsafe delays, by escalating appropriately.
• Work in partnership with patients in line with shared decision-making guidance, explaining options and uncertainties.
• Keep clear, accurate and timely records of significant decisions, including resource allocation and escalation steps.

💡 MINI PRACTICE SCENARIO

A busy acute medical unit has two remaining same-day CT angiography slots. Patient A has suspected pulmonary embolism with tachycardia, pleuritic chest pain and raised D-dimer. Patient B has chronic low back pain and a non-urgent outpatient MRI request that has been delayed several times. Both are distressed; Patient B’s family are loudly demanding that their scan is prioritised.

Best action: Prioritise the CT angiogram for Patient A based on clinical urgency and risk from delay, explain the reasoning to both patients, safety-net Patient B with a clear timeframe and alternatives (for example urgent outpatient review), and document the decision and any escalation.
Why: This uses criteria based on need and benefit, manages expectations transparently, mitigates risk to the lower-priority patient, and records a defensible decision rather than yielding to pressure or first-come-first-served.

🎯 KEY TAKEAWAYS

✓ Prioritise by clinical urgency, expected benefit and risk from delay, not noise, status or convenience.
✓ Consider equality and health inequalities duties, actively tackling barriers such as language, disability and deprivation.
✓ Communicate decisions and timeframes clearly, with robust safety-netting for those who must wait.
✓ Escalate capacity and safety concerns early to seniors or operational leads rather than holding risk alone.
✓ Resist inappropriate queue-jumping requests, while still showing empathy and explaining the situation.
✓ Document your criteria, discussions, inequality considerations, escalation and review plan so decisions are transparent and defensible.

🔗 RELATED TOPICS

* → Safe Handover and Escalation
* → Equality, Diversity and Inclusion
* → Leadership and Managing Conflict in Teams
* → Shared Decision-Making and Consent
* → Recognising and Managing Risk in the Acutely Unwell

📖 FULL PRACTICE QUESTIONS

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

You are the medical registrar covering an acute ward list and radiology has confirmed that only two urgent CT scan slots remain today. Three patients are currently awaiting imaging:

* Patient A: suspected pulmonary embolism (tachycardic, pleuritic chest pain, raised D-dimer).
* Patient B: stable chronic back pain with a long-standing MRI request that has been rebooked several times.
* Patient C: query diverticulitis versus perforation, feverish with localised peritonism but haemodynamically stable.

Families of Patients B and C are agitated and demanding that their relative be scanned first because “we have waited the longest”.

Options:
A. Offer the two slots to the patients whose families are most insistent, to reduce conflict.
B. Use first come, first served, and book the two patients who were added to the list earliest.
C. Prioritise the two patients at greatest risk from delay (for example suspected PE and possible perforation) using clinical criteria.
D. Cancel all three scans until tomorrow in case more unwell patients arrive later.
E. Explain to all three groups how you are prioritising by clinical urgency and benefit, and give realistic timeframes and safety-netting.
F. Ask radiology to “squeeze in” extra scans without explaining the safety issues or capacity limits.
G. Document your prioritisation criteria, decision, and discussions in the notes and handover.
H. Move the patient with the simplest scan first to clear the list more quickly, regardless of risk.

Example SJT — Rank 5 (best → worst)

You are the senior SHO on an acute ward. Only one side room is available. Two patients could benefit:

* Patient X: infectious diarrhoea with suspected C. difficile and profound immunosuppression following chemotherapy.
* Patient Y: non-infectious delirium who shouts at night; their family are angry and demand a side room “for dignity and peace”.
The nurse in charge has asked for your view.

Options:
A. Allocate the side room to Patient X due to infectious risk and vulnerability; provide privacy measures, reassurance and de-escalation strategies for Patient Y; inform the nurse in charge and document the decision and criteria.
B. Give the side room to Patient Y because the family are more vocal and you wish to avoid a complaint.
C. Use first come, first served, and give the room to the patient who arrived on the ward earliest.
D. Leave the side room empty in case a more unwell patient arrives later, keeping both patients on the bay.
E. Move Patient X and Patient Y in and out of the side room in short time slots to be seen as “fair” to both.