Conditions we write for.
Every condition here is mapped to the NHS guideline your GP is expected to follow. Pick yours to see what they should already be doing, by guideline number, by section.
ADHD (adult assessment)
NHS guideline NG87 covers recognition, diagnosis and management of ADHD in children, young people and adults. Adult patients have a legal right under NHS Patient Choice Guidance (NHS England, 19 December 2023) to ask their GP to refer them to any NHS-contracted provider for assessment, this is the NHS Right to Choose pathway.
Autism (adult assessment)
NHS guideline CG142 covers recognition, referral, diagnosis and management of autism in adults. Adult patients have a legal right under NHS Patient Choice Guidance (NHS England, 19 December 2023) to ask their GP to refer them to any NHS-contracted provider for diagnostic assessment, this is the NHS Right to Choose pathway.
Long COVID
NHS guideline NG188 sets out how the NHS should assess, refer and manage people with ongoing symptomatic COVID-19 and post-COVID-19 syndrome. It explicitly covers fatigue, breathlessness, brain fog, post-exertional malaise, and autonomic symptoms.
ME/CFS
NHS guideline NG206 (2021) replaced the old CG53 guideline. It explicitly removes graded exercise therapy as a treatment, requires recognition of post-exertional malaise, and sets a clear diagnostic pathway.
Fibromyalgia
NHS guideline NG193 covers the assessment and management of chronic primary pain, including fibromyalgia. It sets out specific recommendations for assessment, shared decision-making, and which pharmacological treatments should and should not be offered.
POTS / dysautonomia
No dedicated NICE guideline exists for PoTS or wider dysautonomia. Your letter is grounded in the NHS Constitution for England (right to be referred for treatment your GP thinks you need) and the GMC's Good Medical Practice duty to make a referral where a GP cannot provide the assessment themselves. Where PoTS is post-COVID, NHS guideline NG188 (long COVID) may also apply, and your letter mentions it in that context only.
EDS / HSD
No dedicated NICE guideline exists for hEDS or HSD. Your letter is grounded in NICE NG193 (chronic pain in over 16s), which genuinely covers most HSD/EDS sequelae, plus the NHS Constitution for England and GMC Good Medical Practice. The 2017 international hEDS classification (Beighton score plus systemic criteria) maintained by The Ehlers-Danlos Society is the diagnostic reference a specialist would use, and the letter names it as the framework it asks your GP to consider, without pretending it is a NICE guideline.
MCAS
No dedicated NICE guideline exists for MCAS, and there is no BSACI MCAS guideline. Your letter is grounded in the NHS Constitution for England and GMC Good Medical Practice, asking your GP to arrange the investigations an NHS immunology or allergy service would need to see. Once you reach specialist immunology, the international Valent consensus criteria (2012, updated 2019) are the framework a specialist will use, requiring a rise in serum tryptase of at least 20% above baseline plus 2 ng/mL measured within 1 to 4 hours of a symptomatic episode. This page describes the specialist framework for your context, the letter itself does not cite Valent as if it were NICE guidance.
Endometriosis
NHS guideline NG73 sets out a clear pathway for assessment, investigation and referral of suspected endometriosis. It is explicit that diagnosis should not depend on transvaginal ultrasound being normal.
Perimenopause / HRT
NHS guideline NG23 covers identification and management of perimenopause and menopause, including when HRT should be offered, discussed, and reviewed. It is explicit that diagnosis in women over 45 with typical symptoms should not require blood tests.
Adrenal insufficiency
NHS guideline NG243 (2024) sets out how primary care should suspect, test for, and manage adrenal insufficiency, a condition that can be life-threatening if missed. The guideline is explicit about when a 9am cortisol and short Synacthen test should be requested.
Migraine
NHS guideline CG150 sets the diagnostic pathway for migraine and lists the preventive treatments that should be tried (propranolol, topiramate, amitriptyline, and candesartan as an off-label option). Once a patient has failed at least three preventives, separate NHS Technology Appraisals cover CGRP monoclonal antibody injections (TA682 erenumab, TA659 galcanezumab, TA764 fremanezumab, TA871 eptinezumab); TA260 covers Botox for chronic migraine.
Cluster headache
NHS guideline CG150 explicitly covers cluster headache. Acute attacks should be treated with 100% high-flow oxygen and subcutaneous or nasal sumatriptan. In practice home oxygen for cluster headache is specialist-initiated (typically by neurology) rather than prescribed directly by GPs, and the Home Oxygen Order Form (HOOF) is completed by the specialist service. Prevention is usually verapamil with ECG monitoring, with a short corticosteroid course as a bridge. Urgent neurology referral is recommended on first suspicion.
Pathway guides for each condition.
Long COVID · NG188
Long Covid clinic referral
NHS guideline NG188 pathway, sample wording, and what to do if your GP refuses.
Read the Long COVID pathway guide →
ME/CFS · NG206
ME/CFS diagnosis (UK)
NHS guideline NG206, the four core symptoms, and the NHS pathway.
Read the ME/CFS pathway guide →
Fibromyalgia · NG193
Fibromyalgia diagnosis (UK)
2016 ACR criteria, NHS guideline NG193, and the NHS pathway.
Read the Fibromyalgia pathway guide →
MCAS · No NICE guideline
MCAS diagnosis (UK)
The NHS immunology pathway, tryptase testing, and what to request from your GP.
Read the MCAS pathway guide →
Endometriosis · NG73
Endometriosis diagnosis (UK)
Use NHS guideline NG73 to put the referral pathway in writing.
Read the Endometriosis pathway guide →
Free UK patient-rights guides.
Plain-English guides on your NHS rights, your GP's duty of care, and how to get every word of your record. Written for patients, not lawyers.
Your GP's duty of care
What your NHS GP legally owes you, and how to spot a breach.
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How to complain about your GP
The NHS complaints process explained, Stage 1 to PHSO.
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Get your NHS medical records
Your legal right under UK GDPR: free, and usually within 30 days.
Read the guide →