"You mainly suffer from anxiety.", what you've probably been told
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.
What GPs miss
PoTS is often missed because a standing test is not performed. An active stand test or NASA Lean Test is straightforward and inexpensive but rarely offered without prompting.
The letter asks for
- An active stand test or referral for tilt-table testing
- Referral to cardiology, or to an autonomic service or post-COVID clinic where one is available, noting that dedicated autonomic services are few and set their own referral criteria
- Consideration of POTS in the differential diagnosis
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Frequently asked questions
How is POTS diagnosed?
Sustained heart-rate increase of ≥30 bpm (≥40 in adolescents) within 10 minutes of standing, in the absence of orthostatic hypotension, with chronic symptoms. The letter requests the relevant test.
Why doesn't the letter cite a NICE guideline for PoTS?
Because none exists in the UK. Citing an unrelated guideline (like NG206 for ME/CFS) to add the appearance of authority would be a mis-citation any clinician would rightly flag. The letter leans on the NHS Constitution for England and GMC Good Medical Practice instead, which is exactly the correct footing for a PoTS referral request.
What you hear vs. what the guidance says
What's usually said in the room
"You mainly suffer from anxiety."
What the guideline actually says
PoTS is often missed because a standing test is not performed. An active stand test or NASA Lean Test is straightforward and inexpensive but rarely offered without prompting.
Source: NHS Constitution for England + GMC Good Medical Practice (duty to refer)
What to do next
You have just read what the guidance says. The gap most people hit next is getting that in writing, on their record, in front of their GP.
Your GP has not acted on it
We draft a formal letter to your NHS GP citing the applicable NHS guidance, built from a 3 minute assessment in your own words. £39. Free redraft if anything reads wrong.
You send the letter, not us. General information, not medical advice.
Benefits and rights for POTS / dysautonomia
Outcomes from people with POTS / dysautonomia
One short email each Sunday, anonymised stories from people who put their case to their GP in writing.