Gender, Reproductive and Sexual Health Clinical Experience Group (CEG)

What you need to Know: Relevant Topics: Gillick, Fraser and the Law

Gillick Competence

Used to assess if a young person (under 16) can make decisions without parental consent or knowledge, not limited to contraception.

Assessment Criteria: No set defined criteria

• Age, maturity, and mental capacity.
• Understand, risks, benefits, and short-term and long-term consequences
• Ability to explain their rationale for decision-making
• Ability to show understanding of any alternative options
• Capacity to make decisions free from external pressure or influence

 

Consent and Refusal:

• Young people can consent to treatment even if their parents disagree, provided they are assessed as Gillick competent.
• A young person’s refusal of life-saving treatment may be overruled if it would lead to death or severe permanent harm.

 

Child Protection:

• Safety and well-being of the young person must always be prioritized.
• Share child protection concerns with relevant agencies, even if this goes against the child’s wishes.

 

Fraser Guidelines: relates to contraception and sexual health advice and treatment for those under 16 without parental consent.

Criteria:

• The young person has sufficient maturity and intelligence to understand the nature of the treatment.
• They cannot be persuaded to inform their parents.
• They are likely to continue having sexual intercourse regardless.
• Their physical or mental health is at risk without treatment.
• The treatment is in their best interest.

Confidentiality: Can be maintained if all conditions are met, but concerns of coercion or exploitation require disclosure.

Extended Use: Now applies to treatment for sexually transmitted infections (STIs) and pregnancy termination.

 

Children Under 13: Important Considerations:

• There is no lower age limit for applying Gillick competence or Fraser guidelines, but it is rarely appropriate for a child under 13 to consent to medical treatment without parental involvement
• Children under 13 are not legally able to consent to sexual activity, so any disclosure of sexual activity in this age group must be treated as a safeguarding concern and acted upon, regardless of Gillick competence
• Any professional assessing a child under 13 should involve safeguarding authorities immediately due to legal and welfare considerations.

 

 

More Detail: The Sexual Offences Act 2003:

• The age of consent for sexual activity, regardless of gender or sexual orientation, is 16
• Sexual activity with children under 13 is always illegal, as they cannot give consent. Referral to Children’s Social Care or the police is mandatory in such cases
• Sexual activity with individuals under 16 is an offence, even in consensual relationships where both parties are underage
• Although the age of consent is 16, prosecution for consensual sexual activity between young people of a similar age is generally avoided unless there is abuse or exploitation
• For children aged 13-15 engaging in sexual activity, professionals should consider whether to involve other agencies or refer to Children’s Social Care, especially if there are concerns about exploitation or harm
• Young people under 16 are still entitled to confidential advice on contraception, pregnancy, and abortion
• Health professionals and others who act to protect children from harm, including preventing pregnancy or sexually transmitted infections, are not guilty of aiding or abetting a sexual offence
• Sexual activity with 16 or 17-year-olds may still involve harm. It is an offence for someone in a position of trust or authority to have a sexual relationship with them
• Child-on-child abuse (peer-on-peer abuse) is treated as seriously as abuse by adults, particularly where there is coercion, power imbalance, or exploitation
• Sexual grooming is defined as establishing an emotional connection with a child to facilitate sexual abuse, and it is illegal, whether done online or in person.

 

Dr Sakaria Farah
PassCME SCA Tutor

 

References

1. NSPCC (no date) Gillick competence and Fraser guidelines. Available at: https://learning.nspcc.org.uk/child-protection-system/gillick-competence-fraser-guidelines#skip-to-content
2. Care Quality Commission (no date) GP mythbuster 8: Gillick competency and Fraser guidelines. Available at: https://www.cqc.org.uk/guidance-providers/gps/gp-mythbusters/gp-mythbuster-8-gillick-competency-fraser-guidelines
3. West Sussex Safeguarding Children Partnership (2024) Sexual activity involving children and young people. Available at: https://sussexchildprotection.procedures.org.uk/qhkysly#:~:text=There%20should%20always%20be%20a,see%20Making%20a%20Referral%20Procedure.&text=Sexual%20activity%20with%20a%20child%20aged%20under%2016%20is%20also%20an%20offence.&text=In%20consenting%20under%20age%20relationships%2C%20both%20parties%20are%20committing%20offences (Accessed: 4 October 2024).