Gillick Competency & Fraser Guidelines

Step 1 of 5

Gillick Competency & Fraser Guidelines

Structured clinical decision record — Brighton Health Clinic

Legal basis

Gillick competency is the principle established in Gillick v West Norfolk and Wisbech AHA [1986] that a young person under 16 may consent to clinical treatment or support if they have sufficient maturity and understanding to appreciate fully what is proposed. It applies across all clinical services, not only those relating to sexual health.

Fraser guidelines are the five specific criteria Lord Fraser set out in the same judgment for determining whether it is appropriate to proceed without parental knowledge. Clinicians must be satisfied that all five apply before doing so.

The threshold for establishing competency is not fixed — it is proportionate to the complexity and risk of what is being proposed. A young person may have sufficient competency to consent to low-intensity wellbeing support while not meeting the threshold for consent to clinical treatment.

Gillick v West Norfolk and Wisbech AHA [1986] UKHL 7 — Lord Fraser Guidelines

Assessing clinician

Full name *

Role / title *

Date of assessment *

DSL consulted?

Service and young person

Service / pathway *

If other, specify

Young person preferred name *

Date of birth *

Age (calculated)

Case reference

Proposed intervention / support

Why is parental consent not being sought?

This is a required field regardless of service type. It forms a core part of the clinical record.

Fields marked * are required

Step 2 of 5

Gillick Competency

Assess whether the young person demonstrates sufficient understanding and maturity to consent independently

iTick each criterion you are satisfied the young person meets, based on direct assessment in this session. Do not tick on assumption. The threshold required is proportionate to the complexity and potential risk of what is being proposed. You will document specific evidence for each criterion in Step 4.

G1 — Understanding of the proposed support or intervention

✓

The young person understands what is being proposed and what their consent covers

They can describe in their own words what the service or assessment involves, what will be recorded, and who may see that information. This is genuine comprehension, not verbal agreement. Consider whether communication support or adjustments have been made where needed.

G2 — Understanding of the implications

✓

The young person understands what engaging — and not engaging — means for them

They can articulate both the potential benefits of receiving support and the consequences of not doing so. They understand they may withdraw consent at any time and what that would mean in practice.

G3 — Understanding of the limits of confidentiality

✓

The young person understands when confidentiality may be overridden

The limits of confidentiality — including safeguarding situations and information-sharing between agencies — have been explained clearly and in plain language. The young person did not consent on the assumption of absolute confidentiality.

G4 — Emotional and cognitive maturity

✓

The young person demonstrates sufficient maturity to make this decision

Their communication is coherent and the decision appears considered rather than impulsive. They are not in acute crisis at the point of giving consent. Any neurodiversity, learning needs, or communication differences have been taken into account in how this assessment was conducted.

G5 — Absence of coercion or undue influence

✓

The young person is making this decision freely

There is no indication that the decision to engage — or to exclude parents or carers — is being driven or pressured by a third party. The young person did not present as afraid, coerced, or responding to external influence.

Gillick criteria met0 of 5

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Awaiting assessment

Tick the criteria above to generate a competency indication.

Step 3 of 5

Fraser Guidelines

All five criteria must be satisfied before proceeding without parental or carer consent

iThe Fraser guidelines are applied where Gillick competency has been established. They require the clinician to be satisfied on five distinct grounds before proceeding. All five must be met — partial satisfaction is not sufficient to proceed.

F1 — Understanding of the clinician's advice

✓

The young person understands the advice and information the clinician has given

They can demonstrate genuine understanding of what has been discussed, including what their consent covers and what the proposed support or assessment involves. Verbal agreement alone is not sufficient evidence of this.

F2 — Parental or carer involvement considered

✓

The young person has been encouraged to involve a parent or carer and cannot be persuaded to do so

The option of parental or carer involvement has been discussed openly. The young person has given a clear reason for declining, and the clinician has no grounds to override this. The reasons given are credible and have been documented.

iContext matters here. The reason for declining parental involvement should be understood within the context of the specific service. For LGBTQ+ services this may involve identity disclosure risk. For mental health or ADHD support it may involve a history of the young person's concerns being dismissed, parental conflict, or a fear of consequences at home. Document the specific reason clearly regardless of service type.

F3 — Welfare requires action

✓

The young person's health or wellbeing is likely to suffer if they do not receive support

There is a clinical basis for believing that withholding support, or delaying it pending parental consent, would be detrimental to the young person. This does not require a formal diagnosis but should be grounded in their presentation and their own account of their experience.

F4 — Best interests

✓

Proceeding without parental consent is in the young person's best interests

Taking all factors into account — their welfare needs, their clearly expressed wishes, the risks of involving or not involving parents or carers, and their right to privacy — proceeding without parental knowledge is the appropriate course. This is a holistic professional judgement, not a single-factor test.

F5 — Context-specific risk and safeguarding consideration

✓

Any specific contextual risks associated with parental involvement have been assessed and documented

The clinician has considered whether the nature of the service, the young person's circumstances, or their particular vulnerabilities create specific risks if parental consent were sought or confidentiality breached. Examples include: identity-related risk in LGBTQ+ services; risk of parental dismissal undermining engagement with ADHD or autism assessment; domestic abuse or coercive control in the home; or any safeguarding concern that makes parental involvement inadvisable. The assessment reflects these considerations.

Fraser criteria met0 of 5

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Awaiting assessment

Tick the criteria above to generate a Fraser guidelines indication.

Step 4 of 5

Clinical Notes & Outcome

Document the evidence base for your assessment and record your overall determination

iWrite in clear, factual, third-person language. Reference specific observations and, where appropriate, brief verbatim responses from the young person. Avoid interpretive language not grounded in direct evidence from this session. This record may be reviewed by the Designated Safeguarding Lead or clinical supervisor.

Evidence: Gillick competency *

Evidence: Fraser guidelines *

Complexity or uncertainty factors

Overall clinical determination *

Gillick competency established — Fraser guidelines met — proceed

All criteria are satisfied. The young person may consent to the proposed support or intervention without parental knowledge. Complete Step 5 and upload to CP Hub within 24 hours.

Gillick competency established — Fraser guidelines not fully met

The young person demonstrates sufficient understanding and maturity but not all Fraser criteria are satisfied. Do not proceed without Designated Safeguarding Lead consultation first.

Further assessment session required before a determination can be made

Grounds for competency exist but evidence gathered today is insufficient to reach a conclusion. A further session is required. Designated Safeguarding Lead consultation is recommended before the next appointment.

Gillick competency not established — do not proceed without parental consent

The young person does not currently demonstrate sufficient understanding or maturity. Parental or carer consent must be obtained before proceeding, or this case escalated to the Designated Safeguarding Lead immediately.

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Select a determination above

Your overall outcome must be recorded before continuing.

Step 5 of 5

Clinician Signature & Declaration

Sign to confirm this assessment and generate the clinical record

Clinician signature *

Sign in the box below. Your signature will appear on the generated assessment record exactly as drawn.

Draw your signature using a mouse, stylus, or finger

Your signature is embedded directly into the PDF report. It is stored only within this session and is not transmitted elsewhere.

Declaration

By generating this record, you confirm that the assessment above accurately reflects your professional clinical judgement, that you have followed Brighton Health Clinic and Crystal Pathways policy in conducting this assessment, and that this record will be filed in CP Hub as part of the young person's case notes.

This assessment accurately reflects my clinical judgement and the evidence gathered in this session * I understand this record will be stored in CP Hub and may be reviewed by the Designated Safeguarding Lead or clinical supervisor * Where DSL consultation is required by this determination, I confirm it has taken place or is scheduled before the next appointment *