Information for GPs

After the referral
The first appointment
Treatment
Research

Making a referral to our service:

Patients accepted as referrals to the Chronic Fatigue Syndrome/ME Service need to fulfil the following criteria:

• Aged 18 or above, but no upper age limit

• Aged 16-18 and not in full-time education (if in full-time education, patients should be referred to paediatric, adolescent medical or mental health services, as appropriate)

• A primary complaint of unexplained fatigue (this means that pain or other symptoms, if present, are not the primary or dominant complaint, but may be an accompanying symptom)

• No clear alternative medical or psychiatric diagnosis has been made

• The duration is at least 4 months

• We receive copies of normal or negative investigations performed in the last 6 months, as described below:

  • FBC
  • ESR
  • CRP
  • U & Es
  • LFT
  • Bone profile, including corrected calcium
  • creatine kinase
  • Thyroid function tests (TSH and free T4)
  • Local Coeliac disease screen (e.g. IgA endomysial autoantibodies or tissue
  • transglutaminase),
  • Random blood glucose
  • (ferritin if indicated)
  • A urine test will be performed at the first appointmen

• The patient is willing to have a multidisciplinary assessment

• The GP or referring doctor is willing to provide relevant medical reports for benefits agencies, insurance companies etc. These will not be provided by clinic medical staff, but we are happy to provide copies of all clinical letters.


For information on CFS/ME symptoms, diagnosis and management please refer to the NICE quick reference guidelines or full guidelines.

We are happy to receive referrals for patients who have had CFS/ME for a long period of time or who have previously specialist treatment if they meet the above criteria.

Please send your referral letter with blood tests results to:

Mrs Patricia Baker
Clinic Coordinator
CFS/ME Service at St Bartholomew’s Hospital
William Harvey House
61 Bartholomew Close
London EC1A 7BE

Telephone: 020 7601 8108
Fax: 020 7601 7097

After the referral

Our consultants assess each referral letter to see if patients meet the above criteria. If the referral information is complete and the referral seems appropriate, the patient will be offered an initial assessment appointment. Patients may be asked to attend Bart’s for blood tests before assessment if not all of the tests above have been done within the last few months.

If it is thought that a referral to a different speciality would be more appropriate, this will be recommended to you by letter. For example, this could be a suggestion to refer to a sleep clinic to exclude a primary sleep disorder.

The first appointment

This first appointment with one of our doctors usually lasts one and a half hours. It includes history taking, a physical examination and a discussion of the likely diagnoses and treatment options. You and your patient will get a summary letter of this assessment and the management advice.

Treatment

It is not possible for to refer directly to one of our therapists or the multidisciplinary team; patients are assessed first and are then referred on for the appropriate therapy.

The treatment options that are available at our service include Cognitive Behavioural Therapy (CBT) provided by Clinical Psychologists, Graded Exercise Therapy (GET) provided by Physiotherapists and a Return to Work Programme and activity management run by Occupational Therapy.

CBT and GET are the interventions for which there is the clearest research evidence of benefit. There is not yet such strong research evidence in favour of activity management as a stand alone treatment, but many patients find it very helpful in managing their symptoms.

In addition to this, we offer complementary specialist medical care and a CBT and Mindfulness Group for patients that are accepted into our service and their carers/significant others.

Research

We have been researching into the causes, mechanisms and treatment of CFS/ME since 1984. Currently, we are one of the study centres involved in the PACE trial. This large-scale trial is the first in the world to test and compare the effectiveness of four of the main treatments currently available for people suffering from CFS/ME.

We are also currently conducting research into the aetiology of CFS/ME with a study on the cytokine response to activity in collaboration with the department of Infection and Immunity at Barts.