When Can a Parent Access Their Child’s Medical Information? Young Person Consent, Gillick Competence and the Grey Area in Between
- 2 days ago
- 7 min read
Parents are usually closely involved in their children’s healthcare. They book appointments, request prescriptions, speak to clinicians, manage referrals and, quite often, submit requests for copies of medical records.
For younger children, this will rarely cause problems but as children get older, their own rights to privacy, confidentiality and control over their personal information become increasingly important.
This can leave our customers asking when is it still reasonable to deal with the parent, and when do we need to speak to the young person themselves?
The information belongs to the young person
The first important principle is that a child’s data protection rights belong to the child, not to their parent.
A person with parental responsibility may exercise those rights on the child’s behalf in appropriate circumstances, but parental responsibility does not create an automatic entitlement to see everything in a child’s medical record.
Where a young person is sufficiently mature to understand and exercise their own information rights, their own wishes become increasingly important.
The practical difficulty is deciding when a parent can reasonably continue to act on their behalf, and when the practice should establish the young person’s wishes directly.
What happens at age 12?
This is where practices customers can easily overcomplicate things.
For most young people aged 12 and over, the practical starting point should be that they are capable of understanding and exercising their own rights in relation to their health information.
That means a practice should not routinely carry out a Gillick competence assessment simply because a young person has turned 12.
In fact, for the 12+ group, a specific competence assessment should generally be the exception rather than the rule.
The question is not:
“They are 12 now — do we need to assess Gillick competence?”
The better starting point is:
“They are 12 or over, so we will ordinarily treat them as capable of having a say in how their information is used and shared. Is there anything in this particular case that gives us reason to question that?”
A more specific assessment of competence may be appropriate where:
there is evidence that the young person may not understand the particular decision or its consequences;
there are significant learning, cognitive or communication difficulties relevant to the decision;
the decision is unusually complex or significant;
the young person’s responses suggest they do not understand what they are agreeing to or refusing; or
something else about the circumstances gives the practice a genuine reason to doubt competence.
That is very different from treating Gillick competence as a routine gateway that every young person aged 12 or over must pass. For children under 12, the position is different. A younger child may still be sufficiently mature to make a particular decision themselves, in which case a Gillick-style assessment of their understanding may be necessary.
So, in simple terms:
Under 12: competence may need to be positively established where the child wishes to make the decision themselves.
12 and over: competence will ordinarily be the starting assumption, and a specific assessment is only needed where something gives the practice reason to doubt it.
This distinction matters because competence and consent to parental involvement are not the same thing.
A 14-year-old may clearly be competent, but may also be entirely happy for their parent to continue managing appointments, prescriptions and routine healthcare administration.
The issue for the practice is therefore usually not whether that 14-year-old is Gillick competent.
It is whether, in the circumstances of the particular request, the practice should check the young person’s wishes about their parent’s involvement.
Does age 12 mean we suddenly have to contact the young person about everything?
No.
And this is where the issue becomes much more difficult in day-to-day general practice.
The fact that a young person is presumed capable of exercising their own rights does not necessarily mean that a practice must interrupt every established family arrangement and contact the young person each time a parent requests something.
Age should therefore be treated as a prompt to think, rather than an automatic trigger for a completely different administrative process.
There will be many families where the parent continues to manage virtually every aspect of the young person’s healthcare.
For example:
Mum has consistently booked and attended appointments.
She manages repeat prescriptions and referrals.
The young person routinely attends consultations with her.
The young person has never asked to speak to clinicians privately.
There is no indication that they manage their healthcare independently.
There are no safeguarding concerns or indicators of family conflict.
The information being requested is routine in nature.
In circumstances such as these, it may be reasonable for the practice not to contact the young person and to take a documented view that the parent can continue to act on the young person’s behalf.
So we are not saying;
“They are the parent, therefore they are entitled to the information.”
The decision should instead be based on what the practice knows about the young person, the family’s usual arrangements and the nature of the information involved.
Competence and permission are not the same question
This distinction is particularly important, for example, for a 14-year-old, the practice may have no reason whatsoever to doubt that they are competent.
A young person can be perfectly competent while still being entirely happy for their parent to manage appointments, medication, correspondence and other aspects of their healthcare.
Competence does not automatically mean independence.
Equally, the fact that a competent young person has historically allowed parental involvement does not mean that this permission should be assumed indefinitely or for every type of information.
When should we make stronger checks?
The need to establish the young person’s own wishes becomes greater as the risk associated with disclosure increases.
Practices should consider making direct enquiries where, for example:
the young person has previously attended appointments independently;
there are consultations that took place without the parent present;
the young person has asked for information to be kept confidential;
the record contains particularly sensitive information;
there are safeguarding concerns;
there are indications of coercive or controlling behaviour;
the request itself appears unusual or disproportionate;
the parent is requesting extensive historical records rather than information required for ordinary care;
there is evidence that the young person is beginning to manage their own healthcare;
there is disagreement about parental involvement; or
there is anything else within the record which makes disclosure to the parent potentially contrary to the young person’s interests.
The more sensitive the information and the greater the potential consequence of disclosure, the less appropriate it is simply to rely on previous parental involvement.
Separated parents require particular care
Another situation in which practices should generally look more closely is where parents are separated, particularly where there are difficult custody or contact arrangements.
Separation does not, of itself, remove parental responsibility or mean that a parent cannot act on behalf of their child.
However, it can significantly change the risk associated with disclosure.
The practice may need to consider:
who holds parental responsibility;
whether any relevant court orders are in place;
who normally manages the young person’s healthcare;
whether information about one household could inadvertently be disclosed to the other;
whether there is disagreement between the parents;
whether there are safeguarding or domestic abuse concerns;
whether the young person has expressed preferences about parental involvement; and
whether the young person should be asked directly about the particular request.
Where family relationships are contested, relying purely on the fact that a person holds parental responsibility may be insufficient. In these circumstances, the need to establish the young person’s own wishes becomes much greater.
Parental involvement and parental access are not quite the same thing
It is also useful to distinguish between different kinds of parental involvement.
A young person may be perfectly happy for a parent to:
book appointments;
collect prescriptions;
manage repeat medication; or
receive routine administrative information,
while not wanting that parent to have unrestricted access to their complete medical record.
This becomes particularly relevant to online and proxy access.
A young person might continue to benefit from their parent managing appointments and prescriptions without necessarily giving them full visibility of every consultation or record entry.
Consent should not automatically be treated as all-or-nothing.
What about confidential consultations?
A further warning sign is where the young person has used healthcare services in circumstances where they reasonably expected confidentiality.
This might include discussions concerning:
sexual or reproductive health;
mental health;
relationships;
substance use;
safeguarding;
difficulties at home; or
other matters the young person has chosen to discuss without their parent present.
The fact that a parent usually manages the child’s healthcare does not necessarily mean that every part of the record should therefore be disclosed. Healthcare professionals owe duties of confidentiality to children and young people as well as adults.
Where a competent young person has clearly expressed a wish that particular information should not be shared with their parents, that wish should ordinarily carry significant weight, subject of course to the usual circumstances where disclosure may be necessary to protect the young person or another person from serious harm.
A practical approach for practices
1. What is the parent asking to do?
Routine administration is different from obtaining a complete copy of the medical record.
2. What do we know about how this young person normally manages their healthcare?Does the parent genuinely act for them in practice, or is the young person increasingly independent?
3. What is in the information we are considering releasing? Is it routine, or could disclosure have significant consequences for the young person?
4. Is there anything suggesting that the young person expects confidentiality?
5. Are there family, safeguarding, coercion or separation-related concerns?
6. Is there anything which gives us reason to doubt the young person’s competence in relation to this particular decision?
7. Would speaking to the young person materially reduce the risk of getting this decision wrong?
If the answer to that final question is yes, it is probably worth doing.
Record the judgement
Not every case needs to become a lengthy legal assessment, but where a practice decides to release information to a parent without seeking direct confirmation from an older child, there should ideally be enough recorded to demonstrate why that decision was considered reasonable.
For example:
The record has been reviewed. Parent has historically managed appointments, prescriptions and correspondence and routinely attends consultations with the young person. No indication of independent healthcare management, confidential consultations, safeguarding concerns, family conflict or objection to parental involvement identified. Information requested is routine in nature. Parental request considered reasonable in the circumstances.
Conversely, where concerns are identified:
Record contains confidential consultations and evidence of increasing independent healthcare management. Young person’s wishes should be established before information is disclosed to parent.
Or, where competence itself is in question:
There are factors which raise doubt as to whether the young person fully understands the nature and consequences of this particular decision. A specific assessment of competence is required before relying on their decision regarding disclosure.
This shows that somebody actually considered the young person’s rights and the risks associated with disclosure.
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