What is Gillick competence?

The NHS describes it as when a child under 16 has "enough intelligence, competence and understanding to fully appreciate what's involved in their treatment", so they can consent to it themselves.

What are the Fraser guidelines?

Conditions for giving contraceptive advice or treatment to under-16s without their parents' knowledge or consent. The GMC lists five: they understand the advice, you can't persuade them to involve their parents, they're very likely to have sex anyway, their health is likely to suffer without it, and it's in their best interests.

What is the difference between Gillick and Fraser?

Gillick competence is about whether an under-16 can consent to any treatment. The Fraser guidelines apply specifically to contraception (and, in the GMC's guidance, abortion and STI advice and treatment) without parental knowledge.

At what age can a young person consent to treatment?

The NHS says people aged 16 or over are entitled to consent to their own treatment, and 16- and 17-year-olds are presumed to have capacity unless there's significant evidence otherwise. Under 16, they can consent if they are Gillick competent.

Do I have to tell the parents of a 15-year-old who asks for contraception?

No, if the GMC's conditions are met. You should encourage them to involve their parents, but the GMC says you should keep the consultation confidential even if you decide not to provide advice or treatment.

When must I share information about a young person's sexual activity?

The GMC says you must share relevant information with appropriate people or agencies if a young person is involved in abusive or seriously harmful sexual activity, and you should usually share information about sexual activity involving children under 13.

How do I assess Gillick competence?

The GMC says to check whether they understand the nature, purpose and possible consequences of the treatment and of not having it, and can understand, retain, use and weigh the information and communicate their decision.

Gillick Competence and Fraser Guidelines Explained (UK)

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The short version

16 and 17: the NHS says young people aged 16 or 17 "are presumed to have sufficient capacity to decide on their own medical treatment, unless there's significant evidence to suggest otherwise".
Under 16: they can consent if they are Gillick competent. If not, someone with parental responsibility can consent for them (NHS).
Assessing competence (GMC): can they understand the nature, purpose and possible consequences of the treatment, and of not having it, and "understand, retain, use and weigh this information, and communicate their decision"?
It depends on the decision. The GMC says capacity "depends more on young people's ability to understand and weigh up options than on age", and to assess maturity and understanding individually, considering how complex and important the decision is.
Fraser (GMC's five conditions): they understand the advice; you can't persuade them to tell their parents (or let you tell them); they are very likely to have sex anyway; their health is likely to suffer without it; and it is in their best interests.
Confidentiality: the GMC says you should keep these consultations confidential even if you decide not to provide advice or treatment.
Safeguarding still applies: the GMC says that if a young person is involved in abusive or seriously harmful sexual activity, you must protect them by sharing relevant information with appropriate people or agencies, and that you should usually share information about sexual activity involving children under 13.
In PLAB 2 and the SCA, a 15-year-old asking for contraception tests all of this at once, plus safeguarding.

Gillick competence

What the NHS says

The NHS page on consent for children and young people sets out the basics:

Age	Who can consent (NHS)
16 or over	"entitled to consent to their own treatment. This can only be overruled in exceptional circumstances." Aged 16 or 17, presumed to have capacity unless there's significant evidence otherwise
Under 16, Gillick competent	The child can consent to their own treatment
Under 16, not Gillick competent	Someone with parental responsibility, such as a mother or father, a legally appointed guardian, or a local authority designated to care for the child

The NHS also notes that, by law, only one person with parental responsibility needs to give consent, and that in an emergency, where waiting for parental consent would put the child at risk, treatment can go ahead without consent.

How to assess it (GMC)

The GMC's 0–18 years guidance says you can treat a child or young person with their consent if they are competent, or with the consent of a parent or the court. To decide whether they can consent, you must decide whether they can understand "the nature, purpose and possible consequences" of what you propose, "as well as the consequences of not having treatment". Only if they can "understand, retain, use and weigh this information, and communicate their decision to others" can they consent.

In practice, ask open questions and listen to their answers:

GMC element	Question you might ask (written by Confetto)
Understand	"Can you tell me in your own words what the pill does and how you'd take it?"
Retain	Check again later in the conversation, or at the end with teach-back
Use and weigh	"What do you see as the good points and the downsides for you?"
Communicate	Can they tell you their decision clearly?
Consequences of not having it	"What do you think might happen if you didn't use contraception?"

Competence is about this decision, now. The GMC says to assess maturity and understanding on an individual basis, with regard to the complexity and importance of the decision. A young person may be competent for one decision and not another.

The Fraser guidelines (GMC's five conditions)

The GMC says you can provide contraceptive, abortion and STI advice and treatment, without parental knowledge or consent, to young people under 16 provided that:

"they understand all aspects of the advice and its implications"
"you cannot persuade the young person to tell their parents or to allow you to tell them"
"in relation to contraception and STIs, the young person is very likely to have sex with or without such treatment"
"their physical or mental health is likely to suffer unless they receive such advice or treatment, and"
"it is in the best interests of the young person to receive the advice and treatment without parental knowledge or consent."

The GMC cites the case Gillick v West Norfolk and Wisbech AHA [1986] AC 112 for these conditions. The GMC page doesn't use the word "Fraser", but these five conditions are what people usually mean by the Fraser guidelines.

Confidentiality and safeguarding (GMC)

The GMC's 0–18 years guidance pairs confidentiality with a duty to protect:

"You should keep consultations confidential even if you decide not to provide advice or treatment", with exceptions set out elsewhere in the guidance.
"If a child or young person is involved in abusive or seriously harmful sexual activity, you must protect them by sharing relevant information with appropriate people or agencies".
"You should usually share information about sexual activity involving children under 13, who are considered in law to be unable to consent."

The GMC's 0–18 years page on sexual activity lists factors that may point to abuse or exploitation, including:

Factor (GMC wording)	Question you might ask (written by Confetto)
"a young person too immature to understand or consent"	Their understanding shows in how they talk about the relationship
"big differences in age, maturity or power between sexual partners"	"How old is your partner? How did you meet?"
"a young person's sexual partner having a position of trust"	"Is your partner someone like a teacher, coach or carer?"
"force or the threat of force, emotional or psychological pressure, bribery or payment, either to engage in sexual activity or to keep it secret"	"Has anyone pressured you, or given you gifts or money?" "Has anyone asked you to keep it a secret?"
"drugs or alcohol used to influence a young person to engage in sexual activity when they otherwise would not"	"Are drugs or alcohol ever involved when you have sex?"

If you're worried, explain to the young person what you need to do and why, and follow your local safeguarding procedures.

Gillick vs Fraser: the difference

	Gillick competence	Fraser guidelines
What it is	A test of whether an under-16 can consent to their own treatment	Conditions for giving contraceptive (and, in the GMC's guidance, abortion and STI) advice and treatment to an under-16 without parental knowledge or consent
Applies to	Any treatment decision	Contraception, abortion and STI advice and treatment
Key question	Do they understand, retain, use and weigh the information, and communicate a decision?	Do all five GMC conditions apply?
Source to read	NHS consent page; GMC 0–18 years, "Making decisions"	GMC 0–18 years, "Contraception, abortion and STIs"

A young person must be competent to meet the first Fraser condition, but meeting Fraser also needs the other four conditions, including encouraging them to involve their parents.

The exam angle: contraception for a 15-year-old

Both exams can test this. PLAB 2 is set at the level of an F2 doctor. The RCGP's SCA blueprint includes the clinical experience groups "Patient less than 19 years old" and "Gender, reproductive and sexual health". A typical task is similar in both: a 15-year-old asks for contraception and doesn't want their parents to know.

	PLAB 2 (GMC)	SCA (RCGP)
Format	8-minute scenario	12-minute case, video or audio only
Domains	Data gathering, technical and assessment skills · Clinical management skills · Interpersonal skills	Data gathering and diagnosis · Clinical management and medical complexity · Relating to others
What scores (our reading)	Competence assessed, Fraser conditions covered, safeguarding screen, confidentiality explained, options in plain words, non-judgmental	As PLAB 2, plus the RCGP's relating-to-others feedback statements on a judgmental approach and on recognizing and responding to safeguarding concerns

Worked example: a 15-year-old asking for the pill

Example written by Confetto for practice (not a real exam station). Clinical content is kept general; follow current guidance and your local safeguarding procedures in real practice.

Candidate instructions: You are a doctor in general practice. Mia, 15, has come alone and is asking to start the pill. She doesn't want her mum to know.

Doctor: Hi Mia, I'm Dr. Okoro. Thanks for coming in. Before we start, I want you to know that what you tell me is confidential, which means I won't share it with your mum or anyone else without your agreement. The only time I might need to is if I was worried you or someone else was at serious risk of harm, and if that happened, I'd talk to you first. Is that OK?
Mia: OK.
Doctor: What would you like help with today?
Mia: I want to go on the pill. I've got a boyfriend.
Doctor: Thanks for telling me. Can I ask a bit about him? How old is he?
Mia: Sixteen. He's in the year above me at school.
Doctor: And do you feel happy in the relationship? Has anyone ever made you do anything sexual you didn't want to?
Mia: No, nothing like that. We've been together eight months.
Doctor: Have you had sex already, or are you planning to?
Mia: We have. We used condoms, but one split last week, so I want something more reliable.
(Candidate notes: possible need for emergency contraception and a pregnancy test, given the condom split last week. Explores timing and checks.)
Doctor: Have you thought about talking to your mum, or anyone else at home?
Mia: No way. She'd go mad.
Doctor: That sounds hard. Is there anyone you'd feel OK talking to? Sometimes it helps to have someone on your side, and I could help you plan how to tell her.
Mia: Maybe my aunt. Not yet though.
Doctor: That's fine. Let's talk about the options. Can you tell me what you already know about the pill?
(Candidate explains options in plain words, including long-acting methods such as the implant or coil, and why condoms still matter to protect against infections. Asks Mia to explain back how the method she chooses works and what she'd do if she missed a pill.)
Doctor: And if anything changes, if anyone pressures you, or you feel unsafe, you can always come back and talk to me.

What the example shows

Step	What the candidate did	Link to guidance
Confidentiality first, with its limit	Explained clearly at the start	GMC 0–18 years: keep consultations confidential
Safeguarding screen	Partner's age, pressure or coercion, relationship	GMC 0–18 years factors (age difference, pressure); RCGP feedback statement on recognizing and responding to safeguarding concerns
Clinical safety	Picked up the split condom: emergency contraception and pregnancy test	Clinical management
Encouraged parental involvement	Asked about telling mum; offered help; accepted her answer	Fraser condition 2
Assessed competence	Asked her to explain the method back, and what she'd do if she missed a pill	GMC: understand, retain, use and weigh, communicate
Health and best interests	She is already having sex and needs reliable contraception	Fraser conditions 3–5
Non-judgmental, plain words	Neutral questions, no lecturing	RCGP feedback statement on a judgmental approach; GMC interpersonal skills

Checklist: under-16 asking for contraception

Explain confidentiality, and when you might need to share information
See them alone for at least part of the consultation if someone else is there
Ask about the partner: age, how they met, any position of trust
Ask about pressure, gifts or money, secrecy, drugs or alcohol (the GMC's factors)
Under 13: the GMC says you should usually share information
If concerned, explain what you need to do and follow local safeguarding procedures
Check for immediate needs: emergency contraception, pregnancy test, STI testing
Encourage them to involve a parent or another trusted adult
Assess competence: understand, retain, use and weigh, communicate
Check all five GMC (Fraser) conditions
Explain options in plain words, including condoms for infection protection
Teach-back, follow-up and safety-netting
Document competence, the Fraser conditions and the safeguarding screen