Reviewed on : 8 Nov 2026

Reviewed by : Jackie Robinson (Lead Administrator for Neuropsychiatry)

Expires : 8 Nov 2028

There is currently no commissioned chronic fatigue service in Coventry and Warwickshire, but patients can be referred to other areas under the NHS Right to Choose system

Birmingham Chronic Fatigue Service

Birmingham CFS Service accepts referrals from Cov and Warks.  Waiting times are long, so they are requesting that GPs use the information below to help you establish a diagnosis of chronic fatigue syndrome (CFS) in Primary Care, as per NICE guidance [NG206]

Once a diagnosis is established, referrals can be directly allocated to their treatment pathways with shorter waiting times.

We have set up an email advice & guidance pathway to support you during this process; please find details below.

Established Diagnosis

Of CFS or myalgic encephalomyelitis (ME) – includes copies of the relevant clinical correspondence detailing the diagnosis, if available. Refer, patient will be allocated to a treatment pathways

1. Presenting symptoms

• Debilitating fatigue that is worsened by activity, is not caused by excessive cognitive, physical, emotional or social exertion, and is not significantly relieved by rest.
• Exacerbation of symptoms following activity or exercise that is disproportionate to the activity and has a prolonged recovery time that may last hours, days, weeks or longer.
• Unrefreshing or disturbed sleep.
• Cognitive difficulties, sometimes described as “brain fog.”

2. Symptoms have:

• Been present for >3 months.
• Resulted in significant reduction in occupational, educational, social, or personal activities, compared to pre‑illness levels.
• Are not better explained by other illnesses/conditions.

3. Investigations

Carried out at symptom onset, and within the normal range:

• FBC, ESR, CRP
• Ferritin, B12 and folate
• U+Es, LFTs, HbA1c
• TFTs, CK
• Urine for blood, protein and glucose

Also consider, depending on presentation:

• Screen for connective tissue diseases (ANA, anti-CCP) if arthralgia or myalgia are prominent
• Screen for coeliac disease (anti-tTg) if any irritable bowel-type symptoms are present
• If diarrhoea is prominent, consider requesting faecal calprotectin.
• Screen for adrenal insufficiency (morning cortisol or ACTH challenge test) if weight loss, gastrointestinal complaints, or postural hypotension are present
• Serology for infectious diseases (Lyme disease, HIV, hepatitis B/C, TB) if there are risk factors for exposure.
• Cardiovascular exams (ECG, echocardiogram, tilt test) if there is a history of chest pain, frequent palpitations, history of faints, or orthostatic intolerance.
• Neurology tests (brain MRI) if multiple sclerosis is considered possible.
• Sleep studies if there is prominent daytime somnolence.

Diagnosis

Make a diagnosis of CFS if:

• All the criteria of 1 and 2 are met
• All investigations in 3 are normal, including those based on presentation

Referral

If content to make the diagnosis, fill out the form top right and email to bsm-tr.referral@nhs.net

If uncertain, send your queries to cfsenquiries@bsmhft.nhs.uk along with a brief summary of the case and all relevant investigations done so far. Consultants will be happy to advise and guide