Fatigue Service: RFL

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Under Review — this page was due to be reviewed by 17/09/2021. The information shown here may be outdated.

17 November 2020 update:

Due to very high demand for access to this service and staffing pressures, new initial assessment appointments will be deferred for three months from September to December 2020. Read the Fatigue Service Deferral Letter to GPs for full details.

The Royal Free provides an out-patient only, diagnostic and management service for people experiencing persistent fatigue symptoms. This includes:

  • myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
  • post infectious fatigue syndrome (PIFS)
  • secondary fatigue syndromes/fatigue due to other health conditions

Following initial assessment and diagnosis, patients are offered the choice of physical management or psychological wellbeing options, or both.  Physical management can include assessment for hypermobility spectrum disorder, fibromyalgia and orthostatic intolerance/ postural orthostatic tachycardia syndrome; pain and fatigue neuroscience education; support with pacing; managing flare ups; sleep; returning to or staying in work; reintegrating enjoyable activities and promoting quality of life.

Psychological wellbeing options are individualised and patient centred and may involve integrative use of third wave therapeutic approaches including cognitive behavioural therapy (CBT); acceptance and committment therapy (ACT); mindulfness. These approaches are intended to work on the brain-body link to address physiological effects of emotional distress; responses to trauma; and the effects of living with a complex and unpredictable condition/changes to lifestyle/distressing symptoms.

Urgent referrals are usually not seen immediately as, by definition, rapid deterioration is due to a cause other than ME/CFS.

Eligibility criteria


  • Aged 18+
  • Persistent fatigue symptoms for at least three months
  • Other pathology/causes for fatigue ruled out

How to refer

The following clinicians can refer to this service: GPs


Referral methods: e-Referrals

Routine referrals via CHI RSS through e-Referrals.

Urgent (non-2ww) via e-Referrals direct to the hospital.

Details on e-Rs:

  • Speciality: Infectious Diseases
  • Clinic type: Chronic Fatigue Syndrome


Marlborough Clinic, Royal Free Hospital

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