Children and young people

Anyone aged 18 and over is assumed to be a competent adult who can give their consent. In Scotland, the legal age of capacity is 16.

Aged 16-17

Young people of this age are treated as if they were adults. They are assumed to be competent. However, if they refuse a treatment, this can be overridden either by someone with parental responsibility or the courts.

Under 16

It is for the doctor to decide whether a child has reached this level of maturity and understanding

Children under 16 are also often competent. Gillick v West Norfolk and Wisbech Area Health Authority (1985) found that a parent’s right to consent to treatment on behalf of a child ends when the child has sufficient intelligence and understanding to consent to the treatment themselves (when the child becomes “Gillick competent”).

It is for the doctor to decide whether a child has reached this level of maturity and understanding. One challenge, particularly in a large practice, is to apply the guidelines consistently.

Continuing education is important to make sure that all healthcare professionals understand Gillick competence and how to apply it. Unless the patient objects, you should also involve parents or others with parental responsibility, particularly in more serious situations.

If children under 16 refuse a treatment, this can be overridden by someone with parental responsibility or the courts. However, when there is a difference of opinion between the young person and their parents, this is usually resolved within the family. If there is no need for an immediate decision, it is clearly preferable to delay a decision until this can be resolved.

Childhood immunisation

The person with parental responsibility does not necessarily need to be present at the time the immunisation is given

Parents will normally consent to have their children included in the immunisation and surveillance programme, but consent should be sought each time an immunisation takes place. There is no legal requirement for consent to be given in writing.

For consent to be valid, children, or those with parental responsibility, should understand which vaccines are to be administered, the diseases against which they will protect, the risks against not proceeding, the side effects that may occur and how they should be dealt with, and any follow-up action required.

The person with parental responsibility does not necessarily need to be present at the time the immunisation is given – they may arrange for some or all of it to be met by someone acting on their behalf, eg, a grandparent or a childminder, provided that they have consented in advance.

Parental responsibility

For young children who are not competent to give their consent, someone with parental responsibility can give consent to examination or treatment on behalf of a child up to age 18 in England, Wales and Northern Ireland, and 16 in Scotland.

The child’s healthcare can sometimes become a pawn in acrimonious domestic disputes

A mother automatically has parental responsibility unless she lacks capacity herself. A father will have responsibility if:

• He is married to the mother of his child (or was at the time of birth)
• He has made a parental responsibility agreement with the mother
• He has obtained a court order granting him parental responsibility
• The child was born after 15 April 2002 in Northern Ireland, 1 December 2003 in England or Wales, or 4 May 2006 in Scotland and the father is named on the child’s birth certificate.

Where parents have divorced, remarried or are living with new partners it can be difficult to identify who has parental responsibility.

Unfortunately, the child’s healthcare can sometimes become a pawn in acrimonious domestic disputes. In these cases you should be careful to establish who has parental responsibility and seek advice if necessary.

Chaperones

Patients should be offered a chaperone during intimate examinations wherever possible

Good communication is essential when performing any intimate procedure, so discuss the examination with the patient and give them the opportunity to ask questions. GMC guidance states that patients should be offered a chaperone during intimate examinations wherever possible.

The identity of the chaperone should be recorded in the patient’s notes, as should the patient’s consent for a chaperone and the procedure. The chaperone only needs to be present for the examination, not for any further discussion – be careful about revealing confidential information to a chaperone.

Consent dilemmas

Some of the common consent pitfalls MPS sees in GP practices:

• Lack of chaperone training – many receptionists feel it is adequate to stand in the room but behind the curtain, so that they don’t see anything. In addition, some doctors often don’t write down the name of the chaperone in the patient’s notes. It is important that the chaperone can witness the examination and that the chaperone’s details are recorded.
• Consent not properly recorded in the medical records when undertaking a procedure, eg, cryotherapy, ear syringing.
• Consent forms for minor surgery and vasectomies not including detailed risks and benefits of the operation.
• Requests from a third party for results/hospital letter of relative. It is important to ensure patient confidentiality is not breached. Information should only be passed to a third party with the patient’s consent.

MPS Educational Services offers Clinical Risk Self Assessments (CRSAs) to GP practices to help them identify and remedy any risks they might face. More information on CRSAs and other MPS educational products >>