Gillick competence and the Fraser guidelines in PLAB 2
These two get confused because they come from the same 1985 case, but they are not the same thing. Gillick competence is the general principle: a child under 16 can consent to treatment if they have sufficient maturity and understanding to grasp what is involved. The Fraser guidelines are a specific five-point checklist for one situation: providing contraceptive (and by extension sexual health) advice or treatment to an under-16 without parental knowledge. In a PLAB 2 station, using them accurately - and knowing which one you are using - is the mark.
Step by step, with exam phrasing
| Step | What it means in the cubicle | |
|---|---|---|
| 1 | She understands the advice | The young person understands the professional's advice and what the treatment involves. "I need to be sure you understand what the pill does, how to take it, and what it doesn't protect against." |
| 2 | She cannot be persuaded to involve her parents | You encourage telling a parent or trusted adult and she still declines - encouragement, never coercion, and her refusal does not end the consultation. "I'd really encourage you to talk to your mum - is there a reason that feels impossible? Either way, I'm still here to help you." |
| 3 | She is likely to have sex regardless | With or without treatment, intercourse is likely to continue. Refusing contraception would not stop the sex; it would only remove the protection. "From what you've told me, you're going to carry on seeing him - so my job is to keep you safe." |
| 4 | Her health will suffer without it | Unless she receives the advice or treatment, her physical or mental health is likely to suffer. "Without protection there's a real risk of pregnancy, and I think that would harm you." |
| 5 | It is in her best interests | Providing the treatment without parental consent is in her best interests. Document the reasoning against each criterion. "Taking everything together, giving you this safely is the right thing for you." |
When it carries the marks
Under-16 contraception and sexual-health stations, and any station where a young person seeks care without parental involvement. Run the safeguarding screen in parallel: her partner's age, any coercion, exchange of gifts or money, alcohol or drugs. A 15-year-old with a 15-year-old boyfriend and a 15-year-old with a 24-year-old 'boyfriend' are different stations, and recognising the second is usually safety-critical.
Where candidates lose the marks
- Using 'Fraser competent' for general treatment decisions - Fraser is contraception-specific; the general principle is Gillick competence.
- Skipping the safeguarding screen: partner age, coercion and exploitation questions are not optional in these stations.
- Refusing to help unless she tells her parents - that is coercion, and it is precisely what the guidelines exist to prevent.
- Forgetting confidentiality has limits and pretending otherwise: if she is at risk of serious harm, safeguarding overrides it, and you should say so honestly.
- Not encouraging parental involvement at all: the guidelines require the encouragement conversation, not just acceptance of secrecy.
- Failing to assess understanding properly, which is the foundation both concepts stand on.
Apply it in a real station
These station guides use this framework directly:
Practise it out loud, free Browse the free stations
Frequently asked questions
What is the difference between Gillick competence and the Fraser guidelines?
Gillick competence is the general legal principle that an under-16 with sufficient maturity and understanding can consent to their own medical treatment. The Fraser guidelines are a five-point checklist specifically for providing contraceptive and sexual-health advice or treatment to an under-16 without parental knowledge. Fraser is a subset; Gillick is the umbrella.
What are the five Fraser criteria?
The young person understands the advice; she cannot be persuaded to inform her parents; she is likely to begin or continue having intercourse regardless; her physical or mental health is likely to suffer without the treatment; and providing it without parental consent is in her best interests.
Can a Gillick-competent child refuse treatment?
Consent and refusal are asymmetric for under-18s: a Gillick-competent child can consent to treatment, but a refusal of life-sustaining treatment can be overridden by those with parental responsibility or the court. In a station, acknowledge the asymmetry and involve seniors early rather than asserting a hard rule.
When does confidentiality not apply to an under-16?
When there is risk of serious harm: a significantly older partner, coercion, exploitation, abuse, or trafficking indicators. Then safeguarding duties override confidentiality, and the honest move in the station is to tell the young person what you must share and why, rather than promising secrecy you cannot keep.
Frameworks stick when you say them out loud.
Sit a free timed station and practise the phrasing against a patient who answers back.
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