The scene

A GP called the MDU advice line because a young patient had just attended her surgery and asked for contraception. The patient was a 13-year old girl, who said she'd had a relationship with a boy from school but was worried that condoms weren't effective, so wanted to use another more reliable method.

The GP had a long discussion with the patient and was impressed with her level of knowledge and understanding about methods of contraception, and the GP felt she was Gillick competent to consent.

However, the girl appeared physically young, and the GP was concerned about her vulnerability and safety due to her age, as well as her difficult social background. The girl was from a family with social problems, including criminality and drugs, and alcohol use by parents, and although the GP knew that Social Services were aware of the family, she doubted they knew about the patient's sexual activity.

The GP wanted to know whether to proceed with prescribing contraception, and whether to inform Social Services.

MDU advice

The MDU adviser agreed that the situation was very difficult, as there was a need to balance the GP's duty of confidentiality to the patient with her safeguarding duties. It would be important to deal with the matter sensitively to maintain the patient's trust in her doctor.

The adviser explained that at the age 13 or over, the patient may be mature enough to consent to treatment, or sexual activity, but it would be important to assess this thoroughly and document the GP's opinion in the notes. Even if the GP believed the patient was able to consent to sexual activity, she could still be at risk of abuse, depending on the relationship she was in.

The adviser suggested the GP arrange a further discussion with the patient to ascertain whether there was a significant difference in the sexual partner's age, maturity, or power, as well as if there was concurrent use of drugs or alcohol, or any bribery, payment or pressure to either engage in sexual activity or keep it a secret. If the discussion highlighted any concerns of this nature, then the GP should seek consent to disclose this information, or consider disclosure without consent in the patient's and public interests.

The MDU adviser also suggested asking the patient to allow involvement of a parent or other trusted family member, and to discuss the case with the local designated doctor for child safeguarding, documenting any advice given. This discussion could be on an anonymous basis if the patient had not provided consent to disclose her identity.

In terms of contraception, the MDU adviser explained that the GMC makes clear that a doctor can provide contraceptive advice and treatment without parental knowledge or consent to patients under 16 as long as certain conditions are met: the patient must understand all aspects of the advice and its implications and is very likely to go ahead with sexual activity regardless or treatment, while the doctor must believe it to be in the patient's best interests, and has tried but failed to persuade them to involve a parent.

The outcome

The GP decided to arrange a further appointment with the patient to obtain more detail about her sexual relationships, and would ask her to attend with a trusted adult if possible. Once they had more information, they would ask for consent to seek advice from the designated doctor for child safeguarding. If the patient declined this consent, they would proceed with the discussion anonymously.

This dilemma is fictional but based on members' experiences and the types of calls we receive to our advice line.

Request for contraception from patient under 16

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