Fraser Guidelines and consent

Fraser (and Gillick) competency guidelines help healthcare professionals working with children to balance keeping them safe with listening to their wishes. It also aids in gauging a child’s understanding about their situation and whether they are mature enough to make their own decisions about their health.

Gillick competency and Fraser Guidelines are often used interchangeably, with both referring to a legal case that took place in the 1980s. The case itself looked at whether parental consent should be compulsory or not when an under-16 is seeking contraceptive advice or treatment.

Fraser guidelines specifically

Although the UK age of consent is 16, the reality is that some young people will be sexually active earlier than this. This could be down to abuse, manipulation or simply a lifestyle choice. Practitioners including nurses, doctors and pharmacists will therefore often need to provide intimate healthcare advice to patients of 15 or under.

Since a legal ruling back in 2006, Fraser Guidelines can also be applied to advice and treatment for sexually transmitted infections and abortion-related services (Axton v The Secretary of State for Health, 2006).

The guidelines are named after Law Lord, Lord Fraser who made the judgement.

Fraser Guidelines in practice

Any practitioner following Fraser Guidelines should be satisfied of the following:

  • The young person fully understands what you’re telling them, and the implications
  • The young person is completely against telling their parents or carers that they wish to seek advice or treatment (so parents or carers are not able to give consent)
  • The young person’s mental or physical health – or both – will be likely worsen if the advice or treatment they need isn’t administered
  • The young person is highly likely to carry on having sex, with or without contraceptive treatment
  • Even without their parents’ or carers’ consent, treatment or advice is still in the best interests of the young person

Child protection concerns

Healthcare practitioners should always consider any potential child protection issues when using Fraser Guidelines.

Sexual activity under the age of 16 can be a sign of abuse or exploitation. If a child is sexually active and below 13 years of age, a child protection referral should always be made automatically. Likewise, any young person who repeatedly asks for emergency contraception, has frequent STIs or is looking to terminate a pregnancy could also be at risk. 

Relevant agencies should always be made aware of any child protection issues, and any previous concerns about their safety and wellbeing must be explored.

Fraser Guidelines are covered in PDUK’s Gynae Core Skills course

If this is a topic that’s particularly relevant to your career and the patients you work with, our Gynae Core Skills course could well be for you.

An interactive one-day course that’s held entirely online, it’s ideal for flexible learning that fits in around work and home life. Designed specifically for primary care practitioners involved in the management of and referral decisions for women presenting with gynaecological issues, it’s also worth a valuable 7 hours’ CPD.

Spaces are always in demand though sign up while you can!