A serious long-term neurological condition. The old advice to exercise your way out of it was withdrawn for good reason.
Assessed and treated by a GMC-registered GP
Prescriptions, sick notes and referral letters included
A written treatment plan after every appointment
Your NHS records in the room, with your consent
Care led personally by Dr Khan
Attentive, unhurried care that listens properly
Five-star Google reviews from the people we have looked after
Registered with the Care Quality Commission
ME/CFS — myalgic encephalomyelitis, also called chronic fatigue syndrome — is a long-term condition causing profound fatigue, worsening after exertion, unrefreshing sleep and cognitive difficulty. NICE classifies it as a complex, chronic medical condition affecting multiple body systems. It is not a psychological illness and it is not deconditioning.
The single most important thing on this page is what changed in 2021.
NICE rewrote its guideline and told clinicians: do not offer graded exercise therapy, or any programme based on fixed incremental increases in activity. It also stated that cognitive behavioural therapy should be offered only as support for living with a chronic illness — not as a cure, and not on any assumption that the condition is psychological.
That reversal matters because the previous approach caused harm, and a great many people were told for years that they simply needed to try harder. If you were treated that way, you were not failing. The advice was wrong.
The second thing worth knowing: diagnosis can now be made at three months. The old requirement to wait four to six months, and often much longer in practice, delayed the one thing that genuinely helps — learning to pace before you have spent a year crashing repeatedly.
All four must be present, have persisted for at least three months, and not be explained by another condition:
This is the defining feature and the one most often misunderstood. It is not feeling tired after exercise. It is a whole-body worsening — pain, fog, flu-like symptoms, sometimes being unable to get out of bed — that arrives 12 to 72 hours after the effort and can last days or weeks.
The trigger can be trivial: a shower, a phone call, a difficult conversation, standing in a queue. Mental and emotional effort count as much as physical.
Around a quarter of people are severely affected — housebound or bedbound, sometimes needing tube feeding, unable to tolerate light, sound or touch, unable to speak.
These are the people most often disbelieved, and they are the ones who most need care. NICE explicitly requires home-based assessment and support for them. People have died from complications of very severe ME.
No single cause has been established, but the biological abnormalities are real and reproducible:
It is not caused by deconditioning, by unhelpful beliefs about illness, or by a fear of activity. Those models underpinned the previous treatment approach, and NICE moved away from them after reviewing the evidence.
Suspect ME/CFS when all four features are present — debilitating fatigue, post-exertional malaise, unrefreshing sleep and cognitive difficulty — and confirm the diagnosis if they have persisted for three months and other causes have been excluded.
Importantly, NICE says to begin management from the point of suspicion, without waiting for the three months to elapse. Energy management started early prevents a great deal of avoidable damage.
These must be done. There is no test for ME/CFS, but there are tests for the things that look like it and are treatable:
Further tests only where something in the history points to them — not an indefinite search that delays diagnosis for years.
Lie for ten minutes, record heart rate and blood pressure, then stand and record at intervals for ten minutes. A sustained rise of 30 beats per minute, with symptoms, suggests PoTS. Do it at home and bring the readings — for many people, doing it in a surgery is itself too costly.
Anaemia, iron deficiency without anaemia, hypothyroidism, coeliac disease, diabetes, sleep apnoea, depression, an autoimmune condition, Addison's disease, or a medication effect.
Depression is worth distinguishing carefully. In depression, people generally feel worse before activity and often somewhat better afterwards. In ME/CFS, people want to do things and are punished for doing them, sometimes days later.
Fibromyalgia and long COVID overlap substantially with ME/CFS, and many people meet the criteria for more than one. The management approach is largely shared.
Remote consultation is not a compromise for this condition — for many people it is genuinely better. Travelling to a surgery, sitting in a waiting room and holding a conversation can cost days of recovery. Being assessed from your own bed, with the curtains closed, costs nothing.
Once you have an ME/CFS diagnosis, new problems get attributed to it. Cancers, thyroid disease, heart problems and anaemia continue to happen to people with ME.
If something is genuinely new or different, insist it is assessed on its own terms. This happens often enough that it is worth saying directly at the start of an appointment.
NICE requires that people who cannot attend appointments are assessed at home. You are entitled to that. If it is refused, that is not consistent with the guideline, and it is worth saying so in writing.
NICE describes this as staying within your energy limits, planned by you, with support. It is not a graded programme and it does not aim at incremental increase.
Increased fluids and salt — check first if you have high blood pressure — compression garments, standing up slowly, raising the head of the bed, and recumbent rather than upright positions.
People with ME/CFS are frequently sensitive to medication. Start any new drug at a fraction of the usual dose and increase very slowly. Say this to any prescriber — it is recognised in the NICE guidance and is often not known.
Not every service has caught up with the 2021 guideline. Programmes based on graded increases in activity are still occasionally offered, sometimes under a different name.
You are entitled to decline them, and to ask that the recommendation be recorded. The guideline is clear and citing it is reasonable.
There is a large private market selling recovery to people with ME/CFS — mind-body retreats, brain retraining programmes, intravenous infusions, extensive supplement protocols, unvalidated testing. None has good trial evidence, and some cost thousands.
We will give you a straight answer about any of them. Being desperate for a way out is entirely understandable, and it is being monetised.
This page follows NICE guideline NG206 on myalgic encephalomyelitis (or encephalopathy) / chronic fatigue syndrome, published in 2021, alongside NICE Clinical Knowledge Summaries.
The 2021 guideline replaced the 2007 recommendations following a review of the evidence, and reflects concerns about the quality of the evidence supporting graded exercise therapy and reports of harm from people with ME/CFS.
Reviewed against NICE NG206 and NICE CKS guidance current at the date shown above.
No. NICE says do not offer it, and that is unambiguous.
Any programme built on fixed incremental increases in activity is not recommended for ME/CFS, whatever it is called. If one is offered, you can decline it and ask for that to be recorded.
No. NICE classifies ME/CFS as a complex chronic medical condition affecting multiple body systems.
CBT may help you cope with a chronic illness — as it might with cancer or diabetes — but it is not a treatment for ME/CFS and does not assume a psychological cause.
Three months, if all four criteria are met and other causes have been excluded.
And management should start as soon as it is suspected — there is no reason to leave someone without energy management advice while a clock runs down.
A whole-body worsening after activity, typically delayed by 12 to 72 hours, disproportionate to what was done, and slow to recover from.
It is not tiredness after exercise. The trigger can be a shower or a phone call, and mental effort counts as much as physical.
Some people improve substantially, particularly younger people and those diagnosed early. Many stabilise at a reduced level with fluctuation.
Full recovery in adults who have been ill for years is less common, and we would rather be honest about that than promise something we cannot deliver.
The key difference is what activity does. In depression, people often feel somewhat better after doing something. In ME/CFS, activity makes you worse, sometimes days later.
People with ME/CFS generally want to do things and cannot. That distinction matters, and depression can of course develop alongside.
Medication sensitivity is recognised in ME/CFS, and NICE specifically advises starting at lower doses than usual.
Say this to any prescriber — it is frequently not known, and starting at a normal dose can cause a significant setback.
NICE requires that people who cannot attend are seen at home. You are entitled to ask for that.
A remote consultation is also a genuine option — from bed, in a dark room, in writing if speaking is too much.
They overlap heavily, and many people with long COVID meet the ME/CFS criteria.
Post-exertional malaise is the shared feature that matters most, and where it is present the management is essentially the same.
Brain retraining programmes, infusions, extensive supplement protocols and unvalidated testing have no good trial evidence, and costs run into thousands.
Ask what randomised evidence exists before paying anything, and we will give you a straight answer about any specific one.
August 30, 2026
Ongoing
Time to be seen
Appointment length
Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
Cost
Same day, usually
20 minutes
Yes, with your consent
Included
Yes, and told why
£40 for 20 minutes
Varies by practice
Typically 10 minutes
Yes, your full record
Not routinely
Usually
Free
Same day
Often 10 to 15 minutes
Usually not
Sometimes charged
Varies by provider
Often a subscription
Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
Patient reviews
