Appendix G

Clientsunder theage of sixteen, andaged 13 yrsover

The FraserGuidelines

TheFraserGuidelines(1986)setoutgoodpracticeforhealthprofessionalsforthetreatmentoftheunder16age groupwithoutparentalconsent.Thisisconsideredappropriateifthefollowingcriteriaaremet(seebelow)

Inconsideringtheprovisionofadviceortreatmentoncontraception,doctorsandotherprofessionalstaffneedtotakespecialcarenottounderminetheparentalresponsibilityandfamilystability.Thedoctororotherhealthprofessionalshould,therefore,alwaysseektopersuadetheyoungperson totelltheirparentsorguardian(orotherpersoninlocoparentis)orletthedoctorinformthem,thatcontraceptiveadviceisbeingsought andthe natureofanyadvice or treatment thatisgiven.

Exceptionally,therewillbecaseswhereitisnotpossibletopersuadetheyoungpersoneithertoinformtheparentsortoallowthedoctororotherhealthprofessionaltodoso.Thismaybe,forexample,wherefamilyrelationshipshavebrokendown.Insuchcases,adoctororotherhealthprofessionalwouldbejustifiedingivingadviceandtreatmentwithoutparentalknowledgeorconsent,providedthedoctororother healthprofessional wassatisfiedthat:

1.1Frasercriteria:

1.Theyoungpersoncouldunderstand theadviceandhadsufficientmaturity tounderstandwhatwasinvolvedin terms ofthemoral, social andemotional implications.

2.Thattheyoungpersoncouldnotbepersuadedtoinvolvetheparents,norwouldtheyallownotificationtothe parentthat contraceptiveadvicewasbeingsought.

3.Thattheyoungpersonwouldbeverylikelytobeginorcontinuehavingsexualintercoursewithorwithoutcontraceptivetreatment.

4.Thatwithoutcontraceptiveadviceandtreatment,theyoungperson'sphysicaland/oremotionalhealthwould be likelytosuffer.

5.Thattheyoungperson’s’bestinterestsrequiredthedoctororotherhealthprofessionaltogivecontraceptiveadvice and/or treatment,withoutparental consent.

1.2Ifa clientis believed to be under16yearsofage (and atleast13years orover),the pharmacistwillassesstheclient’scompetenceaspertheFraserGuidelines,andaseparatesectiontotheproforma(seeSLA)willbecompleted.Discussionwiththeyoungpersonshouldexplorethefollowingissuesateachconsultation.Thisshouldbefullydocumentedandshouldincludeanassessment oftheyoungperson’s maturity.

1.Understandingofadvicegiven.

2.Encouragedto involve parents

3.Theeffect onthephysical or mentalhealthofyoung person ifadvice / treatmentwithheld

4.Actionin thebestinterestofthe youngperson

Appendix G

Northamptonshire County Council advises theuseoftheNorthamptonshire Integrated Sexual Health Service wherethere is moreinformationon sexualactivityof youngpeopleunder the ageof18

Guidelines for missedpillsuse of EmergencyHormonal Contraception (EHC)

Thereisnotimeinthemenstrualcyclewhenthereisnoriskofpregnancy,particularlyifthewomanreportshavingirregular periods or isunsureof her dates,althoughtheriskin thefirst 3 daysisnegligible

Recommendations*for emergencycontraceptionuseincommonlyoccurringsituations:

Situation / Indicationsforemergencycontraception
Unprotectedsex /
  • Consensualsex,nocontraceptivemethodsused
  • Rape or sexualassault withriskof pregnancy
  • Coitusinterruptus/ failedcoitusinterruptus
  • Ejaculation onexternalgenitalia

Potential failuresof variouscontraceptivemethods
Combinedpills / Ifthreeormore30-35microgramEEortwoor more20microgramEEpillshave been missedin thefirst weekofpilltaking(iedays1-7)andUPSIoccurredinweek1 orthe pill-freeweek
Progestogen-onlypills / IfoneormorePOPshave beenmissedor taken>3hourslate(>12hourslateforCerazette®)andUPSIhasoccurredin the2 daysfollowingthis
Intrauterinecontraception / Ifcompleteorpartial expulsionisidentified ormid-cycleremoval ofanIUD/IUSisdeemednecessaryandUPSI hasoccurredin thelast 7days
Progestogen-onlyinjectables / Ifthecontraceptiveinjectionislate (>14weeksfrom the previousinjectionfor medroxyprogesteroneacetateor>10weeksfornorethisteroneenantate)andUPSI hasoccurred
Barrier methods / Ifthere hasbeenfailure ofabarrier method
Use of liver-enzymeinducers
Liverenzyme-inducingdrugs(includingStJohn’sWort) / Anadditional barrier method is recommendediforal contraceptives,progestogenimplantsorcontraceptive patchandliverenzyme-inducersaretakenconcurrently.EHC isindicatedifthereisUPSI orbarrier methodfailureduring,orinthe 28daysfollowing,use ofliverenzyme-inducers

EHC PHARMACY SERVICES 2014/2016 FG039 Page 1 of 3