Fraser guidelines and Gillick Competence
⚠️ When applying Fraser guidelines for contraception or sexual health in those <16, always consider child protection concerns.
📖 Introduction
- ✔️ Fraser guidelines apply when giving advice or treatment about contraception and sexual health to individuals under 16.
- They can be used by doctors, nurse practitioners, and other healthcare professionals.
- 📌 They also extend to treatment of STIs and pregnancy termination (Axton v Secretary of State for Health, 2006).
🧠 Consent & Gillick Competence
- Children <16 can consent to medical treatment if they show sufficient maturity and understanding.
- This was established in Gillick vs West Norfolk & Wisbech AHA (1985) → the concept of Gillick competence.
- 👉 In practice, clinicians must judge if the young person fully understands the treatment, risks, and alternatives.
✅ Fraser Guidelines Criteria
The healthcare practitioner must be satisfied that:
- 🙅 The young person cannot be persuaded to involve parents/carers, nor allow the professional to do so.
- 🧩 They understand the advice being provided.
- ⚕️ Without treatment/advice, their physical or mental health would likely suffer.
- 💡 It is in their best interests to receive treatment without parental consent.
- ❤️ They are very likely to continue sexual activity, with or without contraception.
🛡️ Child Protection Considerations
- 🔍 Always screen for safeguarding risks when applying Fraser guidelines.
- ⚠️ Under-13 sexual activity = automatic child protection referral.
- 🔄 Repeated STIs or terminations may indicate sexual abuse or exploitation.
- 🚨 Children who are groomed may not recognise they are being abused.
- 📑 Review previous concerns, and explore family/social context for hidden risks.
- 🤝 Share safeguarding concerns with social services/police, even if the child asks for confidentiality.
📚 References
Clinical cases
- 👧 Case 1 – Fraser Guidelines (Age 15): Teenage girl attended GP requesting contraception without parental knowledge. She was in a stable relationship and appeared mature.
Assessment: GP applied Fraser guidelines - she understood the advice, could not be persuaded to inform parents, was likely to continue sexual activity, and her physical/mental health might suffer without contraception.
Management: Contraceptive pill prescribed with counselling on sexual health and confidentiality.
Teaching point: Fraser guidelines allow provision of contraceptive advice or treatment to under-16s if the professional judges it in the young person’s best interest and they meet all five criteria.
- 🧠 Case 2 – Gillick Competence (Age 14): Girl with type 1 diabetes refused insulin dose adjustment despite her parents’ disagreement. She demonstrated clear understanding of risks, benefits, and long-term consequences.
Assessment: Considered Gillick competent - possessing sufficient intelligence and maturity to make her own medical decision.
Management: Her autonomy was respected; diabetes nurse specialist provided tailored education and close follow-up.
Teaching point: Gillick competence applies broadly to under-16s - a child who fully understands the nature and consequences of a treatment decision may consent (or in some cases, refuse) independently.
