Guidance for Community Pharmacists
regarding requests for emergency contraception
and other sexual health advice and services from
young people under age 16 years
Pharmacy
Warning – Document uncontrolled when printed
Policy Reference: id1024
Prepared by: Mary Morton,
Head of Community Pharmaceutical
Services
Lead Reviewer: Mary Morton
Authorised by: Policy, Procedures
and Guidelines Sub Group of ADTC
Distribution
 Lead Officer’s Group for Child
Protection
 Child Protection Action Group
 Director of Public Health
 Medical Director
 Sexual Health Service
 Children’s Services
Method
CD Rom 
E-mail 
Date of Issue: December 2008
Date of Review
When superseded by NHS Highland multidisciplinary
guidance in response to updated legislation
Version: 1
Date: 18/12/08
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Director of Pharmacy
Community Pharmacy Contract Manager
Community Pharmacy Contractors
CHP Lead Pharmacists
Palliative/Community Care Pharmacist
Paper 
Intranet 
Warning – Document uncontrolled when printed
Policy Reference: id1024
Date of Issue: December 2008
Prepared by: Mary Morton
Date of Review: December 2010
Lead Reviewer: Mary Morton, Head of Community Pharmacy Services Version: 1
Authorised by: Policy, Procedure, Guideline Subgroup of ADTC
Page 1 of 5
Guidance for Community Pharmacists regarding requests for emergency contraception and other
sexual health advice and services from young people under age 16 years.
PURPOSE
To provide a practice framework and advice for community pharmacists when providing a range of sexual
health services to young people less than 16 years.
 To outline the law relating to reporting underage sexual activity
 To outline confidentiality policy
 To outline how to assess capacity to consent to treatment
 To outline Fraser guidelines for management of contraceptive consultations with under 16s
 To outline how to distinguish between young people who request treatment or advice following consensual
sex, from those who are coerced into having sex, those being exploited and those who have been sexually
assaulted
SCOPE
All community pharmacists within NHS Highland providing sexual health services to young people.
POLICY STATEMENT
All pharmacists will apply the principles of this guidance when providing access to sexual health services to
young people.
HEALTH & SAFETY / RISK ASSESSMENT
This guidance has been produced as a framework to assist pharmacists to discharge their professional duty to
protect children and to offer appropriate and professional advice and services.
RESPONSIBILITIES
All Community Pharmacists are required to know, understand and apply the principles contained within this
guidance to ensure appropriate decisions are made when young people request sexual health advice/services.
Introduction
These guidelines are intended to assist pharmacists in making appropriate decisions regarding requests for
emergency contraception and other sexual health advice from young people under 16 years.
It is difficult to produce standard procedures that should be used in all cases. Each individual situation needs
to be considered in its own context.
However, the following information will support pharmacists to make decisions about confidentiality,
assessment of competence to consent to treatment and how to identify and report possible sexual abuse or
exploitation.
The law on underage sex and reporting sexual activity in children
The law in Scotland relating to sexual offences in young people is governed by the Heterosexual Sex; Criminal
Law (consolidation) (Scotland) Act 1995
Warning – Document uncontrolled when printed
Policy Reference: id1024
Date of Issue: December 2008
Prepared by: Mary Morton
Date of Review: December 2010
Lead Reviewer: Mary Morton, Head of Community Pharmacy Services Version: 1
Authorised by: Policy, Procedure, Guideline Subgroup of ADTC
Page 2 of 5
Legislation categorises the seriousness of sexual offences according to age: children under 13: children under
16 and children under 18. Children under 13 are considered in law too young to consent to sexual activity.
Where the female is younger than 12 years, she is considered as incapable of consent to sexual intercourse.
Intercourse with a female of this age is rape whether or not she ‘consents’
Where the female is aged 12, she is considered as incapable of giving consent. The crime is unlawful sexual
intercourse.
Sexual activity with a child under 16 (13-15) is also an offence for the male. However, at this age, it may be
considered consensual and therefore treated as a less serious offence.
The law is not intended to prosecute mutually agreed sexual activity between young people of a similar age,
unless it involves abuse or exploitation.
Where there is evidence, or reason to believe that a child may be the victim of sexual abuse, it is essential that
prompt action is taken and that concerns are discussed with appropriate agencies or individuals, usually the
NHS Highland child protection adviser in each Community Health Partnership locality. Contact details will be
issued with this guidance and updated as required.
Confidentiality
Pharmacists and pharmacy staff have a duty to respect and protect the confidentiality of information relating to
an individual that they acquire in the course of their professional activities.
The confidentiality that is owed to a person under 16 years is no less than that that of an older person and can
be breached only where this is a proportionate response. The decision to breach confidentiality should not be
based only on a person’s age. However, the Children (Scotland) Act 1995 is in place to protect children and
states that all health care workers have a statutory responsibility to protect a child and inform relevant
authorities if a young person is being harmed or is at risk of harm.
Sexual offences legislation does not affect the duty of care and confidentiality of pharmacists to young people
under 16. Health professionals are not liable for prosecution when they are acting to protect a child or young
person, for example when providing contraception or sexual health advice to a child under 16. The right to
confidential advice on contraception, pregnancy and abortion extends to all young people, including those
under 13 years, but the duty of confidentiality is not absolute and the younger the person the greater the
concern should be about the possible existence of abuse or exploitation.
Consenting to treatment
A key statutory provision is the Age of Legal Capacity (Scotland) Act 1991, which confers on any young
person, without lower age limit, the right to consent to treatment.
The Act states that “A person under the age of 16 years has legal capacity to consent on his/her own behalf to
any surgical or medical procedure or treatment where, in the opinion of a qualified medical practitioner, he/she
is capable of understanding the nature and possible consequences of the procedure or treatment”
It is interpreted as applicable to all health professionals, including pharmacists, involved with the supply of
contraception and other sexual health advice.
Competency can be understood by the young person’s ability to understand the choices and their
consequences, including the nature, purpose and possible risk of any treatment.
Warning – Document uncontrolled when printed
Policy Reference: id1024
Date of Issue: December 2008
Prepared by: Mary Morton
Date of Review: December 2010
Lead Reviewer: Mary Morton, Head of Community Pharmacy Services Version: 1
Authorised by: Policy, Procedure, Guideline Subgroup of ADTC
Page 3 of 5
If the young person is deemed competent to consent then there is no requirement for parental consent.
In undertaking an assessment of competence to consent, the pharmacist should consider that in presenting to
the pharmacist for advice/service the young person has identified that they are in need of advice/service and
that the pharmacist may be in a position to provide advice/service. This in itself shows some insight into the
consequences of their action and need for treatment.
The pharmacist must also satisfy themselves that the young person understands;
 the nature of the treatment
 how the treatment works
 that it will prevent pregnancy
 how to use the treatment
 the potential adverse effects of the treatment and how these should be managed
Pharmacists should ensure that they have documented that they consider the young person as having the
competence to consent to treatment. In relation to requests for Emergency Hormonal Contraception (EHC)
from 14/15 year olds this is achieved by completion of the appropriate section on the EHC proforma.
Fraser Guidelines for the management of contraceptive consultations with under 16s
The Fraser guidelines arose from the English legal system, but are appropriate for Scotland. Young people
can be provided with contraception without parental consent if:
 The young person understands the advice and is of sufficient maturity to understand it in terms of moral,
social and emotional implications
 He/she cannot be persuaded of the value in informing their parent/carer that contraceptive advice is being
sought
 He/she is likely to begin or continue to have sex with or without contraception
 Without treatment the young person’s physical/mental health is likely to suffer
 The young person’s best interest requires contraceptive advice, treatment or both without parental consent
 The young person needs to demonstrate to the doctor or nurse providing the care that he/she is competent
to give consent
 The young person’s decision should be made freely and without pressure
Recognising abuse or exploitation
Pharmacists have a duty of care to all of their patients and as such must be alert to the possibility of abuse or
exploitation in all young people requesting emergency contraception or other sexual heath advice/service.
It is not the role of pharmacists or any other health professional to ensure the law is used to prosecute
mutually agreed teenage sexual activity between two young people of a similar age unless it involves abuse or
exploitation.
In order to determine whether underage sexual activity is consensual or involves abuse or exploitation it is
expected that a consultation with a young person will involve a slightly more detailed history than with an adult.
There are no firm rules regarding how to recognise abuse or exploitation and it does require professional
judgement.
Pharmacists should consider the following factors which increase the possibility that there is abuse or
exploitation
Warning – Document uncontrolled when printed
Policy Reference: id1024
Date of Issue: December 2008
Prepared by: Mary Morton
Date of Review: December 2010
Lead Reviewer: Mary Morton, Head of Community Pharmacy Services Version: 1
Authorised by: Policy, Procedure, Guideline Subgroup of ADTC
Page 4 of 5
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The age of the person – is he/she under 13 – note the Patient Group Direction (PGD) for supply of
EHC only allows a supply to a young person aged 13 years or greater
Does the person have any apparent learning difficulty
Are there any signs of physical harm such as bruises, burns
Is there any signs of emotional disturbance
Does the young person seem to lack control
Exploring sexual activity
In all situations where a young person under 16 requests sexual services/advice, the pharmacist should
ascertain certain information to assess the consultation for risk of abuse and exploitation. This should be done
in a non-threatening way and as an integrated part of the assessment which takes place at the consultation.
Example of how this may be approached.
“As part of my service to you I have a duty to ensure you are receiving or accessing the health advice you
require. In order to do this I need to ask you a few questions.”
1. Is this the first time you have had unprotected sexual intercourse?
2. Do you have a regular partner? – the response to this may lead you to asking about relationship, age
etc.
3. Do you have any concerns about your sexual activity?
Provision of sexual health service/advice to young person who is under 13 years of age
As the EHC PGD relates to young people who are 13 years or over, in circumstances where a young person
under 13 years requests a service this MUST be referred to the child’s GP or the sexual health service. Where
possible the pharmacist should endeavour to support and assist the child in accessing this service. This may
include the pharmacist contacting the service and arranging an appointment.
Request from young person who is under 12 years of age
As the EHC PGD relates to young people who are 13 years or over, in circumstances where a young person
under 12 years requests a service this MUST be referred to the child’s GP or the sexual health service. Where
possible the pharmacist should endeavour to support and assist the child in accessing this service. This may
include the pharmacist contacting the service and arranging an appointment.
In addition pharmacists MUST advise the child that you also have a duty to report their situation to the police.
Where the sexual relationship is NOT with a member of the child’s family you would encourage the child to let
you contact their parent or another trusted adult to support them. If the child discloses the relationship is with
a member of their family or a person in a position of trust you MUST refer to the police first before contacting
the child’s parents.
All of this can be done with support and advice from the NHS Highland Child Protection Team
(Contact details issued with this guidance should be kept with this guidance.)
REFERENCES
1.
2.
Highland Child Protection Committee Inter-agency Guideline
Royal Pharmaceutical Society of Great Britain - Guidance on Child Protection (August 2008)
Warning – Document uncontrolled when printed
Policy Reference: id1024
Date of Issue: December 2008
Prepared by: Mary Morton
Date of Review: December 2010
Lead Reviewer: Mary Morton, Head of Community Pharmacy Services Version: 1
Authorised by: Policy, Procedure, Guideline Subgroup of ADTC
Page 5 of 5