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Independents' Day

Most Scottish patients go to GP's practice once a year

Phil Peverley

True family planning

Three young sisters book in to see me in three consecutive appointments. Should be an easy one. No doubt they've got colds and their mother wants them sorting out all at once. I press the buzzer and three differently sized but identically sullen girls, Julie-Ann, 16, Chevonne, 14, and Kaysie, 12, file in. Their mother is with them.

It takes two seconds for their mother to blast my colds theory out of the water. 'I want you to put them all on the Pill, doctor,' she announces. 'Ah, shite,' I think to myself, and then have one of those alarming moments when you're not sure whether you've spoken out loud or not.

'Julie-Ann is sleeping with her boyfriend!' bellows the matriarch. 'Is that right?' I venture. 'Yes it is ­ I can hear them through the wall!' yells her mother. Julie-Ann shrinks down in her chair, and so do I.

'What do you say, Julie-Ann?' I ask, with forced bonhomie. 'Do you think you need some sort of contraception?'

'Dunno. Whatever,' mutters the young lady, and I am impressed, despite myself, that she can utter anything at all in this situation.

'And what about your other two girls, Mrs Burberry? How can I help them?' I say, stalling for time.

'Chevonne will be sleeping with her boyfriend too, although she says she isn't. She does everything her sister does. And Kaysie hasn't got a boyfriend but she wants to go on the Pill, too. They do everything together. And it will save time coming back again for when she has.'

Where do you start with a consultation like this? The moral issues are complex; there are legal and social problems; and it could take a month of individual counselling and discussion to work through effectively. I need to find out what has driven them to this. Is it peer pressure? Is it rebellion? Is it a genuine need? Are they Gillick-competent?

And what about the mother? Is she a feckless conduit for their desires ­ an ineffectual parent? Or is she trying to protect her daughters from social forces over which she has minimal control? Is she being stupid or responsible?

I have only a few minutes to sort this minefield out. I need to marshall all my experience and skill and make the best of this mess in the minimal time that I have available. And I have to put it in a language they will understand, and try to communicate the social and legal ramifications of what they are requesting, while maintaining a relationship that will keep their trust and persuade them to come back to me when the inevitable problems. I take a deep breath.

'Mrs Burberry. You want these three girls to go on the contraceptive pill?' 'That's what I said.' 'And you three ladies, is that what you want too?' 'Yeah.' 'Uh-huh.' 'Mm-hmm.'

'Right. OK. My answer is yes, yes and no. Here are your prescriptions. See you in three months. Next please.'

Dr Phil Peverley is a GP in Sunderland

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