Reviewed on : 8 Oct 2025

Reviewed by : Chloe Davoile & GP Gateway Editor

Expires : 8 Oct 2027

The ME/CFS & Long COVID Service

Supporting people with ME/CFS and Long COVID across Coventry & Rugby

Referral criteria

These are the referral criteria for the Coventry & Rugby ME/CFS & Long COVID Service, which is a multidisciplinary service

The team consists of specialists including Occupational Therapy, Physiotherapy, Psychological therapy, Dietitian and medical physician, all of whom are experienced in supporting people with persistent health problems

Patients should meet the NICE 2021 Guideline criteria for diagnosis

ME/CFS:

All of these symptoms should be present:

1) Debilitating fatigue that is worsened by activity, has not been caused by excessive cognitive, physical, emotional or social exertion, and is not significantly relieved by rest

2) Post-exertional malaise after activity in which the worsening of symptoms are:

1. often delayed in onset by hours or days
2. disproportionate to the activity
3. has a prolonged recovery time that may last hours, days, weeks or longer

3) Unrefreshing sleep or sleep disturbance (or both), which may include:

1. feeling exhausted, feeling flu-like and stiff on waking
2. broken or shallow sleep, altered sleep pattern or hypersomnia

4) Cognitive difficulties (sometimes described as ‘brain fog’), which may include problems finding words or numbers, difficulty in speaking, slowed responsiveness, short-term memory problems, and difficulty concentrating or multitasking

Long COVID:

• Previous Covid-19 infection suspected or confirmed
• Symptoms lasting beyond 4 weeks (ongoing symptomatic covid-19)
• Signs and symptoms that have developed during or after an infection consistent with COVID‑19, and are not explained by an alternative diagnosis
• Can present as cluster of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body

If ME/CFS/LC is suspected, consider:

• a medical assessment (including symptoms and history, co-morbidities, overall physical and mental health)
• a physical examination
• an assessment of the impact of symptoms on psychological and social wellbeing

To exclude other possible causes of chronic fatigue, the following conditions should have been considered:

• Primary Sleep Disorder
• Thyroid Disease
• Adrenal insufficiency
• Anaemia
• Vitamin D deficiency
• Chronic infection
• Coeliac disease
• Immunodeficiency
• Fibromyalgia (pain dominates fatigue in clinical presentation)
• Malignancy
• Anxiety/Depression
• MS
• Myasthenia Gravis
• Rheumatic Diseases
• Dementia

Refer to the appropriate specialist if an alternative diagnosis is likely

The following tests should have been completed:

Chest X-Ray in patients with history of cough and/or shortness of breath; timescale: since onset of symptoms

Blood tests within last 6-months Test results for patients with ME /CFS should be normal. Please comment on any abnormalities that can be explained:

• FBC
• CRP, ESR or PV
• Urea and electrolytes including potassium
• Liver function Calcium
• Thyroid function
• Creatine kinase
• B12 Folate
• Vit D
• Local coeliac screen (e.g. IgA endomysial or tissue transglutaminase autoantibodies)
• HbA1c
• Ferritin

Exclusion criteria

• Major psychiatric illness with psychotic or manic features
• Fibromyalgia, where pain is the primary symptom (refer to local referral guidance)
• History of failed rehabilitation specific to ME/CFS & Long COVID unless there are specific reasons to reconsider the role of rehabilitation (please outline these in the referral)
• Concurrent rehabilitation from another service
• Ongoing medical investigations specifically into potential causes of the fatigue

What the service offers

• Multi-disciplinary outpatient assessment
• Consultation and advice in liaison with Primary Health Care Team
• Direct clinical work (group or individual)
• Multi-component rehabilitation for symptom management

Referral email

Email: Cbs.General@uhcw.nhs.uk