Understanding Gillick Competency and Fraser Guidelines: Implications for Healthcare Professionals

Both Gillick competency and Fraser guidelines refer to a legal case from the 1980s which looked at whether doctors should be able to give contraceptive advice or treatment to young people under 16-years-old without parental consent. The Fraser Guidelines build on the Gillick Competency test and refer to comments made by Lord Fraser in his judgement of the Gillick case in the House of Lords (1985). These guidelines relate specifically to the issue of contraceptive advice for under-16s.

Gillick competence is concerned with determining a child’s capacity to consent, while Fraser guidelines are used specifically to decide if a child can consent to contraceptive or sexual health advice and treatment. The ‘Fraser guidelines’ specifically relate only to contraception and sexual health.

Gillick competency and Fraser guidelines help people who work with children to balance the need to listen to children’s wishes with the responsibility to keep them safe. When practitioners are trying to decide whether a child is mature enough to make decisions about things that affect them, they often talk about whether the child is ‘Gillick competent’ or whether they meet the ‘Fraser guidelines’.

The Fraser guidelines require the professional to be satisfied that: the young person will understand the professional’s advice; the young person cannot be persuaded to inform their parents; the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment; unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer.

The Fraser guidelines still apply to advice and treatment relating to contraception and sexual health. However, Gillick competency is often used in a wider context to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions. Practitioners should always encourage a child to tell their parents or carers about the decisions they are making. If they don’t want to do this, practitioners should explore why and, if appropriate, discuss ways they could help them inform their parents or carers.

These guidelines are important for healthcare professionals as they provide guidance on how to balance the need to listen to children’s wishes with the responsibility to keep them safe. They help practitioners determine whether a child is mature enough to make decisions about things that affect them and provide specific guidance on how to provide specific treatment relating to contraception and sexual health.

To find out more about women and girl’s health check out our virtual course Gynae Core Skills for First Contact Practitioners. Course content includes:

• Review of anatomy and physiology of the female genitourinary system
• Overview of gynaecological disorders- Endometriosis, PCOS, Adhesions, Pelvic organ prolapse, Gynae cancer.
• Sexual history taking & promoting sexual health.
• Considerations in performing an intimate gynae assessment such as: cultural, personal, comfort, issues and problems introducing a speculum.
• Diagnosis and management of common gynaecological disorders including pelvic pain, dysmenorrhea, bleeding and heavy menstrual bleeding, common sexually transmitted infections, retained tampon and/or removal of foreign body, vaginal pessary use for prolapse.
• Overview of emergency contraception
• Adolescent sexual health and Fraser Guidelines explored.