QuestionSBA
QuestionChoice
This patient fulfils the Fraser Guidelines and therefore should be prescribed contraception. The Fraser Guidelines are as follows:

- They understand the doctor's advice
- The young person cannot be persuaded to inform their parents that they are seeking contraceptive advice
- They are likely to begin or continue having intercourse with or without the contraceptive treatment
- Unless they receive the contraception, their physical or mental health is likely to suffer
- It is in the young person's best interests to provide contraceptive advice and/or treatment without parental consent
32648
a
Arrange for her to have the implant fitted
QuestionChoice
This would be a reasonable choice if you felt that she was being pressured into intercourse or if there was a suggestion that the intercourse was with someone older or otherwise inappropriate. She has attended her appointment with a partner who appears supportive, and there is no suggestion here that there is abuse in this case
32652
e
Make a referral to safeguarding
QuestionChoice
This patient has clearly stated that she is already having intercourse with her boyfriend and is requesting contraception. Refusing to provide her with treatment is unsafe and not in her best interests
32651
d
Refuse her request
QuestionChoice
This is a breach of confidentiality and would only be acceptable if you felt that she was putting herself or others at risk. It is important that you try to persuade her that involving her parents is a good idea however you cannot force her to tell them, nor can you tell them without her permission
32650
c
Arrange a consultation with her and her parents
QuestionChoice
This patient has fulfilled the Fraser Guidelines to be provided with contraception and has requested the implant, not the contraceptive pill. It is worth exploring her choice to make sure she is fully informed; however, she has requested the implant, and therefore this should be what you provide
32649
b
Prescribe the contraceptive pill
QuestionComment
Additionally to Frasier considerations (and her preference), Nexplanon is the contraceptive of choice in young people due to concerns about reliability of taking the pill and concerns about the effect of Depo on bone mineral density :)
23196
User
subscriber
amygdala
QuestionComment
hope i read the question in the exam 
25877
User
subscriber
HarryDM
Concept
Chapter
# Summary 
 

The Fraser guidelines are a set of criteria that must be met for a health professional to advise a child <16 years old regarding contraception and sexual health without breaking confidentiality. 
  

# Guidelines
 

 1. He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
 2. He/she cannot be persuaded to tell her parents or to allow the doctor to tell them
 3. He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment
 4. His/her physical or mental health is likely to suffer unless he/she receives advice or treatment
 5. The advice or treatment is in the young person's best interests.
 

If all of the above criteria are met, the child is deemed to be "Fraser competent" and can therefore receive advice without breaking confidentiality.
 
If the child does not meet these criteria, parental consent should be sought. 
 
The Fraser criteria apply to England and Wales, while in Scotland it is a similar criteria called the Age of Legal Capacity Act 1991.
 

# NICE Guidelines
 
[NICE Clinical Knowledge Summary (CKS): Contraception](https://cks.nice.org.uk/topics/contraception-assessment/)

# References

[Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security 1985](https://swarb.co.uk/gillick-v-west-norfolk-and-wisbech-area-health-authority-and-department-of-health-and-social-security-hl-17-oct-1985/)

[National Society for the Prevention of Cruelty to Children (NSPCC): Gillick competency and Fraser guidelines](https://learning.nspcc.org.uk/child-protection-system/gillick-competence-fraser-guidelines)
1007
2237
Fraser Guidelines
Topic
29
Paediatrics
6530
Under Fraser Guidelines, competent minors can receive contraceptive advice and treatment without parental consent if it serves their best interests.
A 15-year-old female presents with her boyfriend, who is in the same year at school, to General Practice requesting the contraceptive implant. She and her boyfriend are already sleeping together, and she is adamant that she will not discuss this with her parents. She understands the risk of pregnancy and would like to discuss different types of contraception. She is able to weigh up the pros and cons of each.

What should you do?
a