“Please don’t tell my mum” — a 15-year-old asks for emergency contraception

Candidates: do not open until you have consulted.

Persona and manner

• Mia Kerrigan, 15, in Year 11; you want to do A-levels and become a vet nurse. You live with your mum Lisa, a nurse who works shifts, and your younger brother. Your parents are separated; you see your dad at weekends.
• Nervous, arms folded, speaking quietly and quickly; you glance at the door. You are articulate and you have looked things up online. You are not tearful unless the doctor is unkind.

Opening line — say this verbatim

• “I need the morning-after pill. And please don’t tell my mum — she’ll go mad. Can you just give it to me?”

Volunteer freely if given the space

• Last night, about ten o’clock — so about nineteen hours ago — you had sex with your boyfriend Ethan and the condom split. You realised straight away.
• You looked it up and know there is a pill you can take, and that it is better sooner. You could not get out of school until half past three.
• You are not on any contraception. You have never been pregnant.

Only if asked

• Ethan: he is 17, in the sixth form at your school, and you have been together since March — about seven months. He is your first boyfriend. Your friends know him. He did not pressure you; it was your decision as much as his. He knows you are here and offered to come; you said no.
• You have had sex with him a few times since the summer, always with a condom. Keep back the earlier episode this cycle unless asked directly whether there has been any other sex since your last period, or whether a condom has ever slipped or come off — otherwise it comes out only when you are invited to add anything.
• Periods: regular, every 28 days, last one started ten days ago — “so I think I’m about in the middle, which is the worst time, isn’t it?”
• Health: asthma, blue inhaler only — maybe twice a month; no steroid tablets for years. No other medicines, no herbal remedies; no epilepsy tablets. No allergies. You are not sick easily. Weight “about nine stone”.
• Nobody has ever made you do anything you did not want to do. Nobody older has been involved. Nobody gives you money, gifts, alcohol or vapes for anything. You are not in care and never have been; you have never gone missing. You feel safe at home and at school. Your mum would be upset and disappointed — “she thinks I’m still twelve” — not violent.
• You have not told anyone except your best friend. You have not been tested for infections; neither has Ethan, as far as you know — “he said he’s only been with one other girl”.
• You would like to go on “proper” contraception — you have heard of the pill and the implant — but you do not want anything that means your mum finds out.
• If asked why you did not go to a pharmacy: you were worried about being seen in the chemist near school and about the cost.

Impact on daily life — home and school (only if asked)

• You did not sleep last night and could not concentrate in school; you have mocks in three weeks.
• You are terrified of being pregnant at fifteen — “that would be the end of everything”.
• You are frightened that if your mum finds out she will stop you seeing Ethan.

Ideas, concerns and expectations

• Idea: that the pill “always works” if you take it today, and that the doctor will have to tell your mum because you are under sixteen.
• Concerns: being pregnant; your mum finding out; whether this will be on your record for her to see; whether the doctor will judge you.
• Expectation: to walk out with the pill in the next ten minutes and no fuss.

Cues to deliver, timed

• Minute 2: “Will this go on my record? Mum works at the hospital — can she see it?”
• Minute 4, if the doctor has not asked about Ethan at all: “It’s not like he’s some older bloke — he’s in Year 13. We’re fine.”
• Minute 5, if a coil has not been mentioned by then: “My friend said there’s something that works better than the pill. Is that true?”

If the doctor summarises and asks whether you want to add anything

• If the earlier episode has not come out: a pause — “There was one other time. Last Saturday — six days ago. The condom didn’t split but it… came off a bit when he pulled out. I didn’t think it counted. Does it?”
• If it has: “If I go on the pill, will it be on my record where Mum can see it?”

How to respond to the doctor

• If the doctor says in a sentence or two that what you say stays in the practice unless someone is at risk of serious harm, and asks Ethan’s age and about home: you relax and answer. “OK. That’s fair.”
• If the doctor says “I can’t tell anyone, I promise, whatever you say”: “Really? Even if…?” — then move on. (Do not test the promise further.)
• If the doctor says they must tell your mum, or must have her permission: “Then I’m going to the chemist” — stand up to leave. Sit down again only if the doctor corrects themselves and explains the actual position.
• If the doctor explains that the coil is the most effective option and works for the longest, and that you can be seen at the clinic today or tomorrow, but that the tablet is a good option if you do not want that: you think about it — “I don’t think I want something put inside me today… but could I come back and have it as my proper contraception?”
• If offered the tablet with a clear explanation of when to take it, what to do if you are sick, that it does not protect you for the rest of the month, and when to do a pregnancy test: you nod and repeat it back if asked.
• If the doctor suggests starting ongoing contraception and explains that it can be arranged confidentially and that nothing is sent home: relieved — “Can I do that? Properly?”
• If the doctor asks whether you would be willing to tell your mum, or someone else at home, and explains why it might help: “Maybe my auntie. Not Mum. Not yet.”
• If the doctor offers testing for infections and explains it is a swab you take yourself: “Oh. OK. Do I have to?” — agree if the doctor says it is your choice and explains why it is offered.
• If the doctor says “you’re too young”, “you shouldn’t be doing this” or “what were you thinking”: go quiet, give one-word answers, and say you want to go.
• If the doctor uses jargon (“UPA”, “Fraser competent”, “LARC”, “NAATs”): “Sorry — what?”

Do not

• Volunteer the earlier episode six days ago unless asked directly about other sex since your period or a condom slipping — or until invited to add anything (apart from the timed cues).
• Invent any pressure, violence, an older partner, gifts, alcohol, drugs, going missing, care involvement or online exploitation. If asked, the answers are no — this is a consensual relationship with a boy two years older at the same school.
• Agree to your mum being told today.

Domain marks — with the key facts that earn a 4 at this station

Domain score (educational construct):

This 1–4 domain score and its descriptors are an Acumen educational construct: the GMC publishes the three marking domains and the four-mark maximum, but not the descriptors its examiners use, and it does not publish station mark sheets. See Legal & Regulatory.

Marks are 1 to 4 in each domain; the generic descriptor for each mark is on the mark scheme page, and the structure of the eight minutes is on the 8-minute station page. The full standard for this case is in section 3 and the GMC feedback statements, with examples from this case, are in section 4.

The top row is the full picture of what a competent FY2 could do at this station, including the working diagnosis with its justified differentials, the safety-net and the follow-up; lower rows describe how performance falls away. It is a debriefing aid, not a checklist to recite: nobody says every line in eight minutes, and a 4 is a judgement that the essentials — the italic key facts on the mark sheet — were done well, in plain language and at the patient’s pace. Acumen training standard — the GMC does not publish station mark sheets.

A feedback statement marks where underperformance was identified in the consultation. With PLAB 2 results the GMC may attach any combination of the ten statements to a station — none, one or several. The right-hand column shows what each one looks like at this station. Record the statements that applied in the practice log.

Points of fact the examiner should have to hand

1. FSRH/CoSRH Clinical Guideline: Emergency Contraception (March 2017, amended April 2026; the Faculty is now the College of Sexual and Reproductive Healthcare): the copper IUD is the most effective method; it can be inserted up to 5 days after the first unprotected sex in a cycle, or up to 5 days after the earliest likely date of ovulation, whichever is later. Ulipristal acetate 30 mg is effective up to 120 hours after unprotected sex and is more effective than levonorgestrel; levonorgestrel 1.5 mg is licensed to 72 hours and the evidence suggests it is ineffective beyond 96 hours. Oral emergency contraception taken after ovulation is ineffective. Consider ulipristal first-line when the sex is likely to have been in the 5 days before ovulation, or was 96–120 hours ago.
2. Weight, drugs and other cautions (same guideline): levonorgestrel may be less effective if BMI is over 26 kg/m² or weight over 70 kg — give ulipristal or a double dose (3 mg) of levonorgestrel. With an enzyme-inducing drug offer the copper IUD, or levonorgestrel 3 mg (effectiveness unknown); a double dose of ulipristal is not recommended. A progestogen taken in the 5 days after ulipristal reduces its effect, so hormonal contraception is not started until 5 days after ulipristal (it can be started immediately after levonorgestrel); progestogen in the 7 days before ulipristal may theoretically reduce its effect. Ulipristal is not suitable for women with severe asthma controlled by oral glucocorticoids. Repeat the dose if vomiting occurs within 3 hours. Both oral methods can be used more than once in a cycle. The April 2026 amendment: no interruption of breastfeeding is needed after a single dose of ulipristal, and higher BMI is associated with a higher risk of IUD expulsion.
3. What every emergency-contraception consultation includes (FSRH/CoSRH; NICE CKS Contraception — emergency, last revised October 2025): advice that oral emergency contraception gives no cover for later sex in the cycle; information on all methods of ongoing contraception and how to start them (quick start immediately after levonorgestrel, from day 5 after ulipristal); an STI risk assessment with testing offered; and a follow-up pregnancy test if there is no normal period within 3 weeks. Antibiotic cover may be considered at IUD insertion if the STI risk is high.
4. Age of consent and the law: the age of consent to sexual activity is 16 throughout the UK (Sexual Offences Act 2003 in England and Wales, with equivalent legislation elsewhere); sexual activity under 16 is an offence even if both agree; children under 13 are in law unable to consent, so sexual intercourse with a child under 13 is rape (CKS; Sexual Offences Act 2003 s5 — rape of a child under 13, with ss5–8 covering under-13s — and s9 where the other person is 18 or over, and s13 where, as with Ethan at 17, the other person is under 18 — sexual activity with a child under 16). Unlawfulness alone does not oblige disclosure — the question is harm, risk and capacity.
5. GMC, 0–18 years: guidance for all doctors (in force since 2007; updated 2018 and December 2024): paragraph 63 — you can provide contraceptive, abortion and STI advice and treatment to a young person under 16 without parental knowledge or consent if they understand all aspects of the advice and its implications; you cannot persuade them to tell their parents or let you do so; they are very likely to have sex with or without treatment; their physical or mental health is likely to suffer otherwise; and it is in their best interests. Paragraph 64 — keep the consultation confidential even if you decide not to treat, other than in the exceptional circumstances in paragraphs 46–52 and 57–62. These are the Fraser criteria from Gillick v West Norfolk and Wisbech AHA (1985); “Gillick competence” is the general test of a child’s capacity to consent, and the Fraser guidelines are its application to contraceptive advice. In Scotland the Age of Legal Capacity (Scotland) Act 1991 applies a similar test.
6. Capacity in the under-16s (GMC 0–18, paragraphs 24–26): a young person can consent only if they can understand the nature, purpose and possible consequences of the treatment and of not having it, retain and weigh the information, and communicate a decision; capacity depends more on maturity and understanding than on age, is decision-specific, and must be assessed and recorded for this decision. At 16 capacity is presumed.
7. When information should be shared (GMC 0–18, paragraphs 57–62): a confidential sexual health service is essential for young people’s welfare and fear about confidentiality is the biggest deterrent to seeking help (57); disclose when it is in the public interest or to protect a child from abusive or seriously harmful sexual activity (58); consider each case on its merits (59); you should usually share information about sexual activity involving children under 13, who are considered in law unable to consent — and discuss any decision not to with the named or designated safeguarding professional and record it (60); and usually share information about abusive or seriously harmful sexual activity, including a young person too immature to understand or consent, big differences in age, maturity or power, a partner in a position of trust, force, pressure, bribery or payment, drugs or alcohol used to secure sex, or a partner known to the police or child protection agencies as having abused children (61). You may not be able to judge this without knowing who the partner is — balance the benefit of asking against the loss of trust (62). None of these applies to Mia.
8. Child sexual exploitation screen (Department for Education, Child sexual exploitation: definition and guide for practitioners, 2017; Working Together to Safeguard Children, 2026): exploitation is sexual activity in exchange for something the child needs or wants — money, gifts, drugs, alcohol, affection, status, protection — or for the benefit of a third party, with or without the child’s apparent consent. Ask routinely about an older partner, gifts and money, drugs and alcohol, online contacts, going missing, care status and whether she feels safe. Any concern goes to the practice safeguarding lead the same day; an FY2 never carries it alone.
9. Records and access: a parent with proxy access to a child’s online record may be able to see what is recorded unless the entry is marked confidential or the access has been reviewed — the practice should check Mia’s proxy-access status today (NHS England guidance on proxy access for children and young people sets the review ages; confirm the current wording before quoting it). Record the competence assessment, the safeguarding questions and answers, and the plan — the record is both her protection and yours. Emergency contraception is free from NHS sexual health clinics and GP practices and, under local and national pharmacy schemes, from community pharmacies; confirm the current conditions of the pharmacy service locally before quoting them.
10. Testing (CKS; BASHH): offer chlamydia and gonorrhoea testing by NAAT on a self-taken vulvovaginal swab, with repeat testing after the window period, and HIV and syphilis serology via the sexual health clinic with repeat testing after their longer windows (the current BASHH window periods should be confirmed before quoting figures); partner testing encouraged. A young person under 16 can consent to STI testing and treatment on the same basis as to contraception (GMC 0–18, paragraph 63).

Where candidates lose marks at this station

• “I’ll have to tell your mum.”
• “I promise I won’t tell anyone, whatever you say.”
• Levonorgestrel by reflex — ulipristal and the coil never mentioned.
• No question about other sex this cycle or a condom that slipped.
• The tablet handed over with nothing about vomiting, the rest of the month, a pregnancy test or what comes next.
• Safeguarding questions fired as an accusation — or not asked at all.

Guidelines for this station

• FSRH/CoSRH Clinical Guideline — Emergency Contraception (March 2017, amended April 2026)
• NICE CKS — Contraception: emergency (revised October 2025)
• GMC — 0–18 years: contraception, abortion and STIs (paragraphs 63–65)
• GMC — 0–18 years: sexual activity (paragraphs 57–62)
• GMC — 0–18 years: assessing the capacity to consent (paragraphs 24–28)
• Sexual Offences Act 2003, section 9 — sexual activity with a child (offender 18 or over)
• Sexual Offences Act 2003, section 13 — child sex offences committed by children or young persons
• GOV.UK — Child sexual exploitation: definition and guide for practitioners (DfE, 2017)
• GOV.UK — Working Together to Safeguard Children

Record your three domain marks, your station total, the GMC feedback statements that applied (where underperformance was identified), and what you will keep and change. The form is already labelled with this case and its web address; a copy of your entry is emailed to you, so your practice log builds up in your inbox and can be downloaded.

Record my marks and reflection for P2-32