GMC: 0–18 Years – Guidance for All Doctors: Summary

SJT Textbook: 0–18 Years — Guidance for All Doctors

0 to 18 Years GMC Guidance (Capacity, Consent & Safeguarding)

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

This guidance helps doctors make ethical, lawful decisions for children and young people up to 18. The foundation is acting in the child’s best interests, which requires weighing clinical need, the child’s views, parental perspectives, emotional wellbeing, cultural factors, and the opinions of other professionals. Children and young people must be involved in decisions as far as their maturity allows.

Confidentiality is crucial: many young people will only seek care if they know their privacy is respected. However, confidentiality is not absolute—information must be shared if there is a safeguarding concern or a risk of serious harm. The MSRA SJT frequently tests whether you can balance autonomy, capacity, confidentiality, and safety.

Common exam scenarios include contraception and STI advice in under-16s, refusal of treatment, parental disagreement, safeguarding risks, and when to share information with parents or agencies.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Assess capacity using maturity, understanding, and ability to weigh information.
2. Prioritise the child’s best interests above parental preference.
3. Maintain confidentiality unless disclosure is necessary to prevent harm.
4. Communicate effectively and involve children and young people in decisions.
5. Document views, decisions, and rationale clearly.
6. Seek advice from safeguarding leads or senior clinicians when unsure.
7. Provide lawful, confidential sexual health care to under-16s when competent.
8. Act promptly in safeguarding situations and share information appropriately.
9. Balance emergency treatment duties with consent law—treat first if life-saving.
10. Work collaboratively with parents while recognising the child as an individual.

These traps reflect misunderstanding of capacity, confidentiality, and safeguarding law.

💬 MODEL PHRASES (Use These in SJT Logic)

* “Your information will stay confidential unless there is a risk of harm.”
* “I need to share this concern to keep you safe.”
* “Let’s involve you in the decision in a way that suits your age.”
* “In an emergency, we will treat you in your best interests.”
* “I will document our discussion and the reasons for my decision.”

Y – Your best interests first
O – Offer involvement appropriate to capacity
U – Uphold confidentiality unless unsafe
T – Treat in emergencies without delay
H – Help through clear communication and safeguarding

📋 QUICK FAQ

Can under-16s consent to treatment independently?
Yes—if they are competent (Gillick/MCA principles), they can consent without parental involvement. Can a child refuse treatment?
Yes, but refusal does not override life-saving treatment when in the child’s best interests. Should I always inform parents?
No. Inform parents unless the child is competent and sharing would cause harm or deter them from seeking care. Can I give contraception or STI advice to an under-16?
Yes—if competent and safeguarding concerns are assessed. What if parents disagree with each other?
Act in the child’s best interests and seek senior or legal advice if required.

📚 GMC ANCHOR POINTS

• Best interests – 0–18 guidance
• Consent and capacity – Gillick/Fraser principles
• Confidentiality with safeguarding exceptions – GMC Confidentiality
• Emergency treatment – treat immediately if life at risk
• Communication duties – Good Medical Practice
• Sharing concerns – Protecting Children and Young People

💡 MINI PRACTICE SCENARIO

A 15-year-old requests confidential contraception advice. She understands the risks and benefits and refuses parental involvement. No safeguarding concerns are identified. Best action: Provide confidential contraception advice and treatment. Why: A competent young person can consent independently, and confidentiality supports access to safe care.

🎯 KEY TAKEAWAYS

✓ Best interests override all else
✓ Competent young people can consent independently
✓ Confidentiality is crucial unless safety is threatened
✓ Treat emergencies without delay
✓ Communicate clearly with child and parents
✓ Safeguarding always justifies disclosure
✓ Document everything thoroughly

🔗 RELATED TOPICS

* → Protecting Children and Young People
* → Consent and Capacity
* → Confidentiality in Healthcare
* → Safeguarding and Public Interest Disclosure
* → Sexual Health in Young People

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

A 14-year-old attends requesting testing for chlamydia. She clearly understands the implications and does not want her parents informed. There are no safeguarding concerns.

Options:
A. Inform her parents immediately
B. Assess competence and provide confidential care
C. Refuse testing until a parent is present
D. Explore safeguarding but proceed if none identified
E. Share results automatically with parents
F. Document discussion and rationale clearly
G. Encourage parental involvement but respect her decision
H. Delay testing until she “thinks carefully”

Example SJT — Rank 5 (best → worst)

A competent 16-year-old with severe asthma refuses nebulised treatment during an exacerbation. She is breathless but alert. The parent wants her to receive treatment.

Options:
A. Treat immediately due to risk to life
B. Explore her reasons and re-discuss urgently
C. Ask a senior to help explain the risks
D. Respect refusal fully and do nothing
E. Delay treatment while reviewing guidelines