ÃÛÌÒAPP

When should fatigue be investigated in primary care?

Start investigation of fatigue in primary care if ALL of the following are present:

• Fatigue severe enough to cause a reduction in normal activities.
• Has been present for at least 4 to 6 weeks and is not clearly improving.
• Does not have a clear cause.

What assessments should be performed in primary care?

• Physical examination.
• Measure BMI.
• Ask about sleep.
• Perform STOP-BANG questionnaire (obstructive sleep apnoea screening).
• Assess mental health. Consider using a brief screening questionnaire for depression / anxiety.
• Blood tests (all patients): FBC, UE, LFT, CRP, ESR, TFT, glucose or HbA1c, ferritin, coeliac screen
• Additional blood tests if there are suggestive clinical symptoms or relevant risk factors: auto-antibody screen, CK, HIV, hepatitis B, hepatitis C and vitamin D.

When to refer?

• Symptoms are not clearly improving after 6 to 12 weeks.
• Please enclose primary care assessment and blood results with referral.
• Your practice must be within ÃÛÌÒAPP, North Tyneside or Northumberland catchment.
• Your patient must be over 16 years of age for referral to adult services.

Re-referral

Where necessary, your patient can re-refer themselves to the service within the first year after discharge.

After one year, please repeat the investigations listed above. If these do not demonstrate a need for further investigation, please refer directly to the therapy team and include your interpretation of the results.