The Locomotor Chronic Fatigue Syndrome service is a specialist assessment and management service for adults aged 18 and over living with chronic fatigue syndrome /myalgic encephalomyelitis (ME/ CFS) or suspected ME/ CFS. GPs considering or suspecting a diagnosis of ME/ CFS or post-viral fatigue that has persisted for longer than four months, can refer into the service for assessment and confirmation on diagnosis and advice on further management or appropriate sign-posting.   

The inter-disciplinary team can:

•  Assess and discuss with patients whether symptoms meet the threshold for confirmation of a diagnosis of ME/ CFS
•  Support patients in understanding ME/CFS and make sense of their own patient journey
•  Learn different strategies and skills to reduce the suffering caused by ME/CFS
• Try out different ways of responding to understandable feelings of sadness, anger, worry or fear about ME/CFS
•  Look at life problems and stressors, which can further affect how people cope with your patient's ME/CFS

The Homerton Service webpage can be found here Locomotor ME/CFS Service | Homerton Healthcare NHS Foundation Trust
            
Click here for a link to the October 2021 updated NICE Guidance -

Click here for resources to the British Association of Clinicians in ME for further clinical resources and information - BACME
 

Eligibility criteria

Inclusions

•  Over 18 years old 
• Registered with a City & Hackney GP
• Persistent fatigue impacting on daily life/mood (over 4 months duration) with associated symptoms that suggest chronic fatigue syndrome  (see NICE guidelines and key diagnostic considerations)
• Open to exploring self-management approaches 
• Appropriately investigated relating to persistent fatigue. The following tests should have been completed within the last 6 months and found to be normal: 
• urinalysis for protein, blood, and glucose
• full blood count
• urea and electrolyte
•  liver function
• thyroid function
• erythrocyte sedimentation rate or plasma viscosity
• C-reactive protein
• calcium and phosphate
• HbA1c
• serum ferritin
• coeliac screening
• creatine kinase

Use clinical judgement to decide on additional investigations to exclude other diagnoses (for example, vitamin D, vitamin B12 and folate levels; serological tests if there is a history of infection; and 9am cortisol for adrenal insufficiency). 
 

Exclusions

• Not registered with City & Hackney GP
• Red flags
• Any active medical condition that may explain the presence of chronic fatigue, such as untreated hypothyroidism, sleep apnoea and narcolepsy, and iatrogenic conditions such as side effects of medication, chronic Hep B or C. 
• Any past or current diagnosis of a major depressive disorder with psychotic or melancholic features
• Alcohol or other substance abuse, occurring within 2 years of the onset of chronic fatigue and any time afterwards.
• Ongoing medical investigations indicated regarding fatigue 
• Ongoing assessment/treatment in another service for same/related condition (including Locomotor Pain/Physiotherapy and ESP Service – we can liaise with treating clinician to determine timing/appropriateness of concurrent treatment)
• Currently active suicidal intent 
• No goals/ not open to exploring self-management 
• For consideration: Patients over 65 with recent onset of fatigue symptoms consider referral to an elderly care physician

How to refer

The following clinicians can refer to this service: