Posting for traffic: Gillik competency test for 11 year old

[Nevergoodenoughforthem]

My DD has just turned 11 years old. She has epilepsy and has been medicated for a number of years. Has regular appointments with her consultant and is doing well.

I order her medication via my online GP portal, the same as my other DC who are slightly older.

When she turned 11 proxy access was removed so I can no longer order her medication via our GP. The only option is via the pharmacy with a slip of paper. They then send that to her GP who signs it off and returns it back to the pharmacy. I have to allow at least 10 working days due to supply issues.

The only way to resume normal order is to have a face to face appointment with the GP for her to be assessed under the Gillik competency test. To be clear, she is 11 years old and given that she is on long term medical care, doesn’t actually fall into the category of needing this test in order for my to have proxy access however our GP is refusing to move forward without an appointment.

It’s utterly ridiculous in these circumstances. I’ve raised the matter with PALs who are seriously concerned about the amount of GP appointments are going to be used unnecessarily. Each practice could have literally hundreds of 11 year olds suddenly being told they need to be assessed incorrectly.

So question is, how far reaching is this? Is it actually a primary care scandal or is my GP practice just misinterpreting the guidelines, in which case what on earth should I do (bar take my DD out of school for an unnecessary appointment- we have enough medical appointments).

Also, my other DD is a year old and didn’t have to do any test (and I still have proxy access to order her medication).

Very odd, our medical practice just spoke with DD and asked if they were still happy for me to be involved and that was when she was 16! She has ADHD and kept missing appointments etc

Yes it sounds stupid. Can you setup an account in her name on the GP website and then just carry on ordering as normal?

It’s madness. I had to fight with the GP practise to give me permission to order online for ds (13) it was only when I pointed out that the two hour window they had for phoning to order them wasn’t compatible with working people that they eventually gave in.

from what I could tell each practise pretty much sets their own rules which makes even less sense!

i would do a formal complain to the practise manager.

Have you spoken to the practice manager? Sounds like the doctor must have got it wrong.

Surely she just needs to go with you to gp surgery and speak to receptionist to give you ongoing permission? This is all we have done with my DD (and recently my parents too).

Ah so a few good point raised here:

• Assessments must be done by GP. It’s not enough for us to pop to GP and tick a box or speak to reception. I don’t actually know what the test involves and the reception team/Practice Manager are unable to tell me.

• I have spoken to the practice manager who informed me that thems the rules. She cited various guidelines at me which I have read and from what I understand, do not apply to my DC. She’s not come back to me on these points even after my chasing and PALs involvement.

Oh we had this fight! It started when ds was 12 years old, the surgery would no longer let us order any prescriptions without a Gillick competence test, even when a hospital consultant had prescribed the drug! So we tried to get an appointment to do it, (it has to be a face to face GP appointment at our surgery), but couldn’t get one!! Tried again, it got cancelled!! It’s a bloody joke, and not in our ds best interests that’s for sure.

My understanding of gillick competence is assessing an under 16 year olds ability to understand and consent to things if there is no adult to consent for them. I’ve never heard of having to be assessed under 16 when there is an adult to give consent.

DS2 is 17, our GP practice have no issue with me consenting on his behalf. DS1 is 24 and suffers with health anxiety and ADHD. He was convinced he was dying of cancer and got so overwhelmed when calling for test results etc we just popped along to the drs, he spoke to the receptionist and it’s on his notes now that they can discuss his medical records with me.

In that scenario, the process makes perfect sense @Newname71 doesn’t it, but this is the reverse and I feel as though I’m going around in circles with them.

How can she give content to allow me to carry on with proxy access if she’s not deemed competent? And if she is deemed competent (she won’t, she’s 11!), I wouldn’t be allowed access and therefore unable to order medication directly with her own GP.

I’m so cross that I’m taking a GP appointment away from someone who actually needs it.

That's ridiculous. I ordered and picked my sons meds when he was 12 and after he turned 16 he signed a bit of paperwork allowing me full access to his doctors so I can book appointments, speak to them on his behalf. Unless your child wishes to refuse treatment why would they dispute the requests??

@Sirzy I agree, doesn't seem at all like there are national rules as our 12yo has had no questions or suggestion that he should order his own medication! He would not have a clue and his ADHD meds are controlled so how would that work since an adult needs to pick them up?

Also, though I may be complete off base, I was under the impression that Gillick wasn't all or nothing. So DS may be competent to refuse or consent to blood pressure being taken but wouldn't understand the long term implications of missing his epilepsy meds.

Our surgery won't allow online access at all, under any circumstances between 11-16. It's because of competency but for the reverse rational. The rational is that between those ages, a child may have the ability to request an appointment/treatment without their parents and that allowing online access could breach their privacy if the parent accesses their account. E.g. contraception.

It made no difference that my now 18 year old has SEN - the computer said no.

It does seem to vary from practice to practice. I had this when DD turned 14. She has learning disabilities and various other conditions. I just spoke to the practice manager and she continued my access to online prescribing for DD. I don't know what is going to happen when she turns 18.

Same thing happens here - DC kicked off my online log in once they hit 12, and aren't allowed their own until they're 16.

Gillick competence is to assess whether an under age child is able to understand a plan of treatment and therefore consent to it - it came about when a mother tried to stop her daughter accessing contraception.

What are the GP proposing - that if assessed as Gillick competent she can give permission for you to continue managing her meds, or that if Gillick competent she can manage them herself? And what do they propose if she isn't Gillick competent?

It's all very computer says no.

@Nevergoodenoughforthem in Scotland the gov, nhs and schools all cut parents out at age 12. This has caused no end of problems for my ds and I. I ended up having to get him a full cognitive assessment, at 15 he is not and never will be gillikic competent due to his disability (anyone who spends 5 mins with him can tell), I've had to send copies of his assessment to his school, the council, the Scottish government, gps and hospital just so they deal with me instead of him.
I really do get how much of a pain it is but in the long run it may make things easier for you

That’s interesting @Lougle how many 11-16 year olds would seek direct medical care without their parents I wonder? A small minority I’m sure, maybe more at the 15-16 bracket but my 11 year old wouldn’t be able to make her own GP appointment, or make her own way to said appointment without me.

So they’ve made guidelines based on the few rather than the majority by the sounds of it?

I could understand if an older child might not want their parents to know about a few specific issues or if there were safe guarding concerns but to take a blanket approach will result in parents having to jump through more hoops to get essential medical treatment, and delay those patients who need appointments because of all the hundreds of gillik tests being run.

I think your practice is wrong on this. It is not a national policy. Someone may have misinterpreted something along the way. Speak to the Practice Manager and get this sorted urgently.

@Hoardasurass I’m so sorry you’ve had to go through all of that. It can’t imagine how frustrating it was. Age 12 too. What are the reasons for such wide spread policy?

Does anyone know why this has happened in the first place? The cases I’ve read concern children of about 16 year who didn’t want their parents to know they had requested contraception.

Similar to @Lougle our surgery refuses online access to all under 16s for the same reason. The pharmacist was unaware and suggested it would be easier for us to order repeat prescriptions online... until I explained that we couldn't. He agreed it was ridiculous and said he would take it up with the practice manager.
As far as I understand, this is a practice led decision - the form for online access actually has a section about children, so it is clearly not a national issue.
I have pointed out that for children with regular prescriptions it is just more work for parents, and given that once they turn sixteen they can get access and immediately delegate to me, it makes no sense!

Good luck getting the policy changed - I am still fighting this.....

I object to the way this is being done by GPs - had similar in our practice.

Gillick competence is not a 'one and done assessment' - for each treatment/medication the child has to be shown to fully understand that particular treatment and it's side effects. It should also be down to the child to request the assessment - not the insistence of the GP.

My concern about this is that once the GPs have ticked their 'Gillick competence' box they can then ignore parental concerns and not bother checking for fully informed consent.

It is also important to remember that Gillick competence (and Fraser guidelines which are specifically related to sexual health/contraception) only allows a child to be involved in accepting a treatment/medication - it does not allow them to refuse a treatment that others have decided they should have.

It is very concerning how parents are being pushed out of this, with an almost instant assumption that they are unnecessary or even harmful to the child.

If she lacks competence you retain automatic proxy rights.
If she has capacity ( which most 11 years old would FOR THIS DECISION) then she can give or refuse you proxy access.
Just do it … you will need to do this at some point in the next couple of years anyway.

Usually it's whether they are capable of making a decision about a specific treatment, however in cases such as my sons a blanket not gillikic competent can be applied.
Unfortunately many people and public bodies have decided to assume that all children are gillikic competent in all decisions at any age from 12-14, its ridiculous

But not now @olympicsrock its outrageous at this young age and isn’t at anyone request. It’s a huge push on HNS resource to take up GP appointments.

Never mind the fact I have to take her out of school, and wait months for an appointment.