Fraser guidelines and Gillick Competence

When using Fraser guidelines for issues relating to sexual health, you should always consider any potential child protection concerns

Introduction

• Fraser guidelines apply specifically to advise and treatment about contraception and sexual health.
• They may be used by a range of healthcare professionals working with under 16-year-olds, including doctors and nurse practitioners.
• Fraser guidelines can also be applied to advise and treat for sexually transmitted infections and the termination of pregnancy (Axton v The Secretary of State for Health, 2006).

Consent to medical treatment can be given by a child under the age of 16 if s/he is 'Gillick competent'

• Children under the age of 16 can consent to medical treatment if they have sufficient maturity and judgement to enable them fully to understand what is proposed.
• This was clarified in England and Wales by the House of Lords in the case of Gillick vs West Norfolk and Wisbech AHA & DHSS in 1985

Practitioners using the Fraser guidelines should be satisfied with the following

• The young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment (or to allow the practitioner to inform their parents or carers).
• The young person understands the advice being given. the young person's physical or mental health or both are likely to suffer unless they receive the advice or treatment.
• It is in the young person's best interests to receive the advice, treatment or both without their parents' or carers' consent.
• The young person is very likely to continue having sex with or without contraceptive treatment. (Gillick v West Norfolk, 1985)

Child protection concerns

• When using Fraser guidelines for issues relating to sexual health, you should always consider any potential child protection concerns
• Underage sexual activity is a possible indicator of child sexual exploitation and children who have been groomed may not realise they are being abused.
• Sexual activity with a child under 13 should always result in a child protection referral.
• If a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of child sexual abuse or exploitation.
• You should always consider any previous concerns that may have been raised about the young person and explore whether there are any factors that may present a risk to their safety and wellbeing.
• You must always share child protection concerns with the relevant agencies, even if a child or young person asks you not to.

References

• NSPCC Gillick competency and Fraser guidelines