• Carmel Conefrey, Cynthia Ochieng, Christin Hoffman, Daisy Elliott, Kerry Avery, Joanne Bennett, Natalie Blencowe, Sarah Duff, James Kinross, Angus McNair, David Messenger, Anne Pullybank, Baljit Singh, Anni King, Sarah E Squire, Jane Blazeby, Barry Main, and Leila Rooshenas.
• Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
• Br J Surg. 2022 Dec 13; 110 (1): 929792-97.

BackgroundAt the onset of the COVID-19 pandemic, elective surgical provision was severely affected by the need for hospital reorganization to care for critically ill patients. In response, National Health Service (NHS) England issued national guidance proposing acceptable time intervals for postponing different types of surgical procedure. This study reports healthcare professionals' private accounts of the strategies adopted to manage the imbalance of demand and resource, using colorectal cancer surgery as a case study.MethodsTwenty-seven semistructured interviews were conducted with healthcare professionals between June and November 2020. A key informant sampling approach was used, followed by snowballing to achieve maximum regional variation across the UK. Data were analysed thematically using the constant comparison approach.ResultsIn the context of considerable resource constraint, surgical teams overcame challenges to continue elective cancer provision. They achieved this by pursuing a combination of strategies: relocating surgical services; prioritizing patients within and across surgical specialties; adapting patient treatment plans; and introducing changes to surgical team working practices. Despite national guidance, prioritization decisions were framed as complex, and the most challenging of the strategies to implement, both practically and emotionally.ConclusionThere is a need to better support surgeons tasked with prioritizing patients when capacity exceeds demand.© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.

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