Implementation of a Chronic Fatigue Syndrome (CFS) pathway at the Living Well Partnership(LWP), Primary Care Network (PCN)

Refat, Lamiaa, Sanford, Chris and Aggarwal, Pritti (2025) Implementation of a Chronic Fatigue Syndrome (CFS) pathway at the Living Well Partnership(LWP), Primary Care Network (PCN). British Journal of General Practice, 75. (doi:10.3399/bjgp25X742149).

Abstract

Background: evidence suggests that early identification and treatment of CFS improve patient outcomes, reduce the risk of prolonged disability, and prevent unnecessary investigations. The Pathway was developed and implemented in January 2023 to standardise the diagnosis and management of suspected CFS cases in LWP, PCN.

Aim: to implement a standardised diagnostic approach using structured questionnaires and mandatory investigations, enhance GP confidence in managing complex fatigue cases, ensure timely and accurate referrals through specific criteria, reduce repeated patient contacts for fatigue, and integrate social prescribing to support patients with confirmed CFS.

Method: the CFS pathway identifies prolonged fatigue symptoms through E-consults. Patients complete a CFS questionnaire, followed by a comprehensive GP review Including blood tests screening for underlying conditions. The integration of CFS questionnaire with Arden's CF template supports decision-making based on both subjective and objective findings. Furthermore, inclusion and exclusion criteria guide appropriate referrals to the chronic fatigue service.

Results: between February and May 2023, 66 patients were coded with fatigue, subsequently 8 confirmed CFS cases, alongside diagnoses of iron deficiency anaemia, monoclonal gammopathy of undetermined significance, Coeliac disease and hepatitis: 7 patients were referred to CFS service with an approximate wait-time of 4 weeks. GP feedback indicated increased confidence in managing complex fatigue presentations and improved patient experiences. Additionally, integration of social prescribing has been implemented to support confirmed CFS cases.

Conclusion: this pathway demonstrates the effectiveness of structured care for chronic conditions in reaching a diagnosis, for example, CFS in primary care, highlighting the importance of interdisciplinary approaches for holistic patient care.

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Contributors

Author: Pritti Aggarwal

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