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 Newcastle, 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.
