Teenage Confidentiality Policy and Fraser Guidelines
Created
GP Signature
(To confirm policy and procedures)
Table of Revisions
Review Date
Pre 2012
INTRODUCTION
This policy is specific to patients under the age of 18, and should be read in conjunction with
the Staff Confidentiality Policy and Agreement and Fraser (Contraceptive) Guidelines
POLICY
The principles of confidentiality apply equally to all patients regardless of age. Young people
(including those under 16) are entitled to equal confidentiality as all other patients. This
includes respecting their wishes to withhold information from parents or guardians. The GP
involved will determine the competency of a young person seeking treatment and will
determine the extent to which confidentiality guidelines apply in each case.
Care must be taken to ensure that this right of confidentiality is not inadvertently breached
by following the procedural guidelines in force.
Any young person regardless of age can independently seek medical advice or treatment,
including surgical procedures, if a health professional believes that they are capable of
understanding the choices of treatment and their consequences. This includes contraceptive
advice, but the principles apply to other treatments, including abortion.
The policy of the Practice is to support young people in exercising their choice of medical
treatment, and to deal with them in a sympathetic and confidential manner. Where a young
person presents at the surgery without adult support they may be booked in to see a
clinician in the normal way. Where there is some question of the urgency of an appointment
the matter should be referred to a nurse in the first instance to triage the request.
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FRASER GUIDELINES, TEENAGERS and CONSENT & CONFIDENTIALITY
There is no minimum age in Scotland in terms of legal capacity to consent to medical
treatment and so it is legal for a young person under 16 to approach and use sexual health
services. Young people also have rights of self determination given to them in The Age of
Legal Capacity (Scotland) Act 1991 which assigns various legal rights to young people of any
age, including the legal capacity to consent to surgical, medical or dental procedure or
treatment.
There may still be debate however about when a young person might be competent to make
their own decisions and seek out services, and worries about whether adequate efforts have
been made to encourage under 16’s to involve their parent(s) in the issues or decisions
which they are facing.
When agencies talk about the assessment they make as to whether a young person can be
provided with confidential sexual health services without parental consent they often talk
about using what has been called the Fraser Guidelines. The guidelines arise from the case
in the early 80’s when Victoria Gillick attempted to set a legal precedent in England and
Wales which would have meant that medical practitioners could not give young people
under the age of 16 treatment or contraceptive services without parental permission. Initially
successful the ruling was eventually changed when the House of Lords ruled that people
who are under 16, who are fully able to understand what is proposed, and its implications,
are competent to consent to medical treatment regardless of age. This is now the legal
position in England and Wales. In Scotland, the ruling has also been interpreted as meaning
that medical practitioners can give contraceptive advice or treatment to young people under
16 without parental knowledge.
In making his judgement the Law Lord, Lord Fraser, offered a set of criteria which must
apply when medical practitioners are offering contraceptive services to under 16’s without
parental knowledge or permission. The so-called Fraser Guidelines (some people refer to
assessing whether the young person is Gillick competent) state that all the following
requirements should be fulfilled. The guidelines have proved such a useful tool that most
agencies offering information, advice or services to young people about their sexual health
have adopted the Fraser Guidelines as the basis for best practice.
The guidelines suggest that before providing a service to under 16’s to which parents have
not given consent the staff member should ensure that the following criteria are met:
The Fraser Guidelines:
1. The young person understands the advice being given.
2. The young person cannot be convinced to involve parents/carers or
allow the medical practitioner to do so on their behalf.
3. It is likely that the young person will begin or continue having
intercourse with or without treatment/contraception.
Jenner House Surgery - Teenage Confidentiality and Fraser Guidelines
4. Unless he or she receives treatment/contraception their physical or
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updated October 2014
mental health (or both)
is likelybut
tonot
suffer.
5. The young person’s best interests require contraceptive advice,
treatment or supplies to be given without parental consent.
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Further, in terms of the Law Lords judgement, although a young person or their partner may
still be committing an offence if having sex under the age of 16 Lord Fraser also stated that
“doctors giving such advice in good faith are not committing a criminal offence of aiding and
abetting unlawful intercourse with girls under 16”.
Further consideration must also be given to the special situations some young people might
be in. Being subject to a supervision order does not affect an under 16’s capacity or rights to
consent to medical treatment and young people with a physical or learning disability have
the same right to appropriate sex education, contraceptive information, confidential advice
and treatment as any other young person. They may also have particular individual needs
which a professional person may have to consider, but their rights to services remain the
same.
Finally, where a professional cannot provide a necessary service it is within the law to
provide information, make an appointment or accompany a young person to an agency who
does provide what the young person needs and to do this without parental knowledge. It is
worth noting however that some individual agency policies, for example in schools, might
not permit this.
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