GPAtlas🧭 When to assess competence
Assess competence whenever a child or young person under 18 wants to make a healthcare decision on their own, particularly where:
• Their view conflicts with a parent's.
• The decision touches a sensitive area such as contraception, STI treatment, abortion, vaccination, or mental health.
The legal question is not the child's age alone but whether they have the maturity and understanding to make this particular decision.
Three skills run through every such consultation: establish who can lawfully consent, respect confidentiality as the default, and never miss a safeguarding concern. Competence determines who decides; the child's best interests and welfare remain the overarching priority throughout.
| Group | Legal basis | Who can consent to treatment |
|---|---|---|
| Under 16 | Gillick competence (common law) | • The young person, if Gillick-competent for that specific decision • Fraser guidelines gate sexual-health care without parental knowledge |
| 16–17 years | Family Law Reform Act 1969 s.8 · MCA 2005 | • Presumed to have capacity • Consents as an adult • A parent cannot override their consent |
| Not competent or lacks capacity | Children Act 1989 · best interests | A person with parental responsibility, or the court – provided treatment is in the child's best interests. |
One line is absolute: a child under 13 cannot consent to sexual activity in law, so any disclosure of sexual activity in an under-13 is always a safeguarding referral (Sexual Offences Act 2003).
Source: GMC 0–18 years · NSPCC · Sexual Offences Act 2003
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