Changes

June 2025 — reviewed. A literature search was conducted in March 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Recommendations have been updated in line with current evidence in the literature. Text regarding the diagnosis and management of suspected or confirmed myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has been removed and links to a new CKS topic on Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have been written.

Update

Goals

To support primary healthcare professionals to:

• Identify any underlying cause of tiredness using investigations, where appropriate.
• Arrange referral to an appropriate specialist, if needed.
• Provide advice on management in primary care.
• Provide advice on sources of information and support.

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

No audit criteria were found during the review of this topic.

QOF indicators

No QOF indicators were found during the review of this topic.

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

No NICE quality standards were found during the review of this topic.

What is it?

• Tiredness/fatigue is a common, non-specific symptom in primary care [Ho, 2022]. There is no universal definition, and the experience and perception are subjective [Nicholson, 2015] [Maisel, 2021]. Fatigue may be described as:
  • Listlessness, lack of energy, exhaustion, tiredness, early fatigability, sleepiness, a tendency to fall asleep during the day, physical weakness, or a feeling of 'running on empty' [Maisel, 2021].
  • A sensation of exhaustion during or after usual activities, or a feeling of inadequate energy to begin these activities [Cornuz, 2006].
  • A lack of energy, feeling weak or being too tired to participate in family, work, or leisure activities [Nicholson, 2015].
  • An unpleasant physical, cognitive and emotional symptom described as a tiredness not relieved by common strategies that restore energy. It varies in duration and intensity and reduces the ability to perform usual daily activities [Galland-Decker, 2019].
  • A complex multifactorial symptom impacting on physical, mental, cognitive, emotional, and motivational dimensions, among others [Billones, 2021].

What causes it?

• Fatigue symptoms can be a non-specific indicator of underlying physiological or physical pathology, psychosocial factors, or a combination of causes [Nicholson, 2015] [Stadje, 2016] [Ho, 2022].
  • Physiological causes include pregnancy, breastfeeding, or an imbalance in routines of rest or sleep, exercise, diet, shift work, or other activity not attributed to an underlying medical condition [Ho, 2022].
    • Night shift workers are particularly at risk of fatigue because their day sleep is often lighter, of shorter duration, and more easily disturbed due to daytime noise and difficulty sleeping during daylight hours [HSE, 2025].
  • Physical causes include anaemia, diabetes mellitus, viral or post-viral infections, other infections, sleep disorders, or malignancy [Maisel, 2021; Ho, 2022]. See the section on Differential diagnosis for more information.
  • Drug causes include benzodiazepines, antidepressants, antihistamines, antihypertensives, antipsychotics, antivirals, beta-blockers, cannabis, cocaine and other stimulants, muscle relaxants, nicotine, and opiates [Maisel, 2021; Ho, 2022].
  • Psychosocial causes include depression, anxiety, stress, loss, bereavement, burnout, and other adjustment reactions [Hamilton, 2010; Maisel, 2021; Ho, 2022].
    • A Dutch prospective primary care study of 93,297 patient-years that explored four common physical symptom presentations, found a physical or psychological cause was identified in two-thirds of cases of fatigue, but in one-third of cases no specific cause was found [Okkes, 2002].

How common is it?

The reported prevalence of tiredness/fatigue varies according to case definitions, methods of assessment, population group, and study settings, and it is likely to be under-reported [Stadje, 2016] [Dukes, 2021].

• A systematic review of tiredness studies states that it is one of the most frequent presenting symptoms in primary care [Stadje, 2016]. A review article states that an estimated 5–10% of primary care attendances are directly related to fatigue [Dukes, 2021].
• In a UK community-based postal survey sent to an age- and sex-stratified random sample of 2474 adults from 20 GP practices, 50% of people with chronic disease reported feeling tired/run down as a symptom, and it was the most commonly reported symptom out of 25 possible symptoms [McAteer, 2011].
• In a large UK population-based postal survey (n = 15,283 adults), 10–18% of people self-reported current tiredness/fatigue that had lasted one month or longer. The relative risk of fatigue in women compared with men was 1.3 [Pawlikowska, 1994].
• A UK general practice database study (1990–2001) found that the annual incidence of new tiredness/fatigue was 1.5% [Gallagher, 2004].
• An Irish primary care study of 1428 consecutive GP consultations on one sample day found that [Cullen, 2002]:
  • The prevalence of reported fatigue was 25%.
  • Fatigue was the primary reason for attending in 6.5% and the secondary reason in 19% of consultations.
  • 62% of patients attending with fatigue were female and the mean age was 47.1 years.
• A Swiss population-based cross-sectional survey (n = 2848) found the prevalence of fatigue was 21.9% in the general population [Galland-Decker, 2019].
• A Canadian comparative study of the Canadian electronic primary care database (n = 103 fatigue symptom patients and 103 non-fatigue symptom patients) found [Nicholson, 2015]:
  • The period prevalence of presentation with fatigue was 8.2% over a 1-year follow-up period.
  • The majority of affected patients were women and over the age of 60 years.

What are the risk factors?

Various risk factors for tiredness/fatigue as a presenting symptom have been identified in different studies.

• A questionnaire-based cross-sectional study in Sweden (n = 1557 adults) exploring the four categories of general fatigue, physical fatigue, reduced activity, and mental fatigue, found that [Engberg, 2017]:
  • Women had higher fatigue scores than men on all subscales.
  • Lower socioeconomic status was generally related to higher levels of fatigue.
  • Lower physical activity was connected to higher levels of fatigue for all subscales, except mental fatigue, and longer time spent sitting was also related to more fatigue on all subscales, except mental fatigue.
  • Lower self-rated health was strongly associated with higher levels of fatigue for all subscales.
• A Swiss population-based cross-sectional survey (n = 2848) found that people reporting fatigue were [Galland-Decker, 2019]:
  • More likely to be female.
  • Had a higher body mass index (BMI).
  • More likely to have lower educational attainment.
  • Less likely in those aged 64–74 years.
• A Canadian comparative study of primary care records (n = 103 fatigue symptom and non-fatigue symptom patients) found [Nicholson, 2015]:
  • 68% of people with fatigue symptoms were female.
  • 88% had an associated chronic condition.
  • 52% had an associated psychosocial condition or comorbidity.

What are the complications?

Possible complications of tiredness/fatigue include:

• Negative impact on quality of life — including on relationships and family life, social, and leisure activities [Billones, 2021; Ho, 2022].
• Impact at work, education, or training — excessive working time or poorly designed shift patterns may  result in reduced productivity and performance; slower reaction times; increased risk of errors and burnout; and increased risk of occupational hazards, accidents, and injury. The risk is increased if work is machine-paced, complex, or monotonous [Billones, 2021; Maisel, 2021; HSE, 2025].
• Emotional and psychological — may result in loss of interest and motivation; increased risk of anxiety and depression [Billones, 2021; Maisel, 2021]. See the CKS topics on Generalized anxiety disorder and Depression for more information.
• Cognitive — including reduced mental activity and performance; reduced ability to process information; memory lapses; decreased awareness; lack of attention; under-estimation of risk [Billones, 2021; Maisel, 2021; HSE, 2025].
• Increased risk of accidents and road traffic collisions — fatigue has been implicated in 20% of accidents on major roads [HSE, 2025].
• Prognosis of comorbid conditions — fatigue may affect the clinical course of comorbid disease, including treatment compliance and disease outcomes [Park, 2024].
• Excess mortality risk — a UK prospective population-based cohort study (n = 18,101) found that after adjusting for confounders, the hazard ratio for all-cause mortality was 1.4 for people who reported highest compared with lowest fatigue levels, during a mean follow-up period of 16.6 years. The association was particularly strong for deaths related to cardiovascular disease [Basu, 2016].

What is the prognosis?

• Almost three-quarters of people presenting with fatigue in primary care do not require further follow up, suggesting a high rate of spontaneous resolution [Hamilton, 2010].
• Between a third and a half of people with tiredness/fatigue as a major or concurrent symptom in primary care recover within one year. Factors associated with an increased likelihood of, or speed of recovery, include [Nijrolder, 2008a; Nijrolder, 2008b]:
  • Male sex.
  • Reduced severity and shorter duration of fatigue.
  • No expectation of fatigue becoming chronic.
  • Perception of better general health and mental health.
  • Lower levels of pain.
  • Good social support and no carer responsibilities.
  • Willingness to attribute fatigue to psychological factors.

How should I assess an adult with tiredness/fatigue?

If an adult presents with tiredness/fatigue:

• Ask about:
  • The person's experience of fatigue, including symptom onset, severity, frequency, duration, fluctuations, and any triggers or relieving factors, including the effect of rest, sleep, and activity on symptoms.
    
    • Daytime sleepiness may indicate sleep apnoea or another sleep disorder. A symptom and sleep diary may be helpful for the person. See the CKS topics on Obstructive sleep apnoea syndrome and Insomnia for more information.
    • Muscle weakness may suggest a neuromuscular cause, such as Parkinson's disease, multiple sclerosis, or myasthenia gravis.
  • Any additional symptoms, such as post-exertional malaise, sleep difficulties or disturbance, and cognitive difficulties which may suggest a diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). See the CKS topic on  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) for more information.
  • Any clinical features suggesting an underlying or coexisting condition including the chance of pregnancy which may help to explain symptoms.
    
    • Ask about stress or stressful life events and clinical features of anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder. See the CKS topics on Depression, Generalized anxiety disorder, and Post-traumatic stress disorder for more information.
    • Assess for clinical features of chronic cardiac, respiratory, renal, liver, autoimmune and/or rheumatological conditions, or chronic pain which may cause or be associated with fatigue. See the CKS topics on Asthma, Chronic obstructive pulmonary disease, Chronic kidney disease, Chronic pain, Heart failure - chronic, Jaundice in adults, Polymyalgia rheumatica, and Rheumatoid arthritis for more information.
  • The impact of symptoms on the person and relatives/carers, including physical activity and mobility, dexterity, balance, and risk of falls; activities of daily living and independence; cognitive function; family life, impact on dependents, carer stress; sex and relationships; occupation including working time and/or shift pattern, training, and/or education; psychological, emotional, and social wellbeing including leisure activities, hobbies, and social interaction.
  • Sources of social support including informal carer support.
  • The person's diet; weight history and use of any restrictive or alternative diets; smoking history; alcohol consumption and any recreational drug use; sexual and travel history.
  • The person's housing situation and possibility of carbon monoxide poisoning. See the CKS topic on Carbon monoxide poisoning for more information.
  • Any prescribed and over-the-counter medications, including vitamin and mineral supplements and herbal remedies.
• Examine the person, depending on the presenting clinical features, to assess for an underlying or coexisting condition.
  • Perform a general examination and assess nutritional status including body mass index (BMI) and weight history. See the CKS topic on Adult Malnutrition for more information.
  • Assess for signs such as pallor (may suggest anaemia or malignancy), lymphadenopathy (may suggest infection or malignancy), goitre (may suggest thyroid disease), pulse (for arrhythmia), blood pressure (for postural hypotension), heart murmur (may suggest valvular heart disease or endocarditis), oedema (may suggest cardiac or liver disease), muscle weakness (may suggest a neuromuscular cause), neurological deficit (may suggest a neurological cause).
  • Perform a mental state examination to assess mood and cognitive functioning.
• Consider arranging investigations to exclude an underlying or coexisting condition in which fatigue can be a primary feature, depending on clinical judgement, such as:
  • Full blood count and serum ferritin — to assess for anaemia, polycythaemia, haematological malignancy. See the CKS topics on Anaemia - iron deficiency and Haematological cancers - recognition and referral for more information.
  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) — may be raised in infection, inflammation, autoimmune conditions, and rarely solid organ neoplasms and lymphoproliferation. See the CKS topic on Multiple myeloma for more information.
  • Liver function tests — to assess for underlying liver disease. See the CKS topic on Jaundice in adults for more information.
  • Renal function tests — to assess for acute kidney injury or chronic kidney disease and/or electrolyte imbalance. See the CKS topic on Acute kidney injury and Chronic kidney disease for more information.
  • Thyroid function tests — to assess for possible hypo- or hyperthyroidism. See the CKS topics on Hypothyroidism and Hyperthyroidism for more information.
  • HbA1c — to assess for possible type 1 or type 2 diabetes mellitus. See the CKS topics on Diabetes - type 1 and Diabetes - type 2 for more information.
  • IgA tissue transglutaminase — to assess for coeliac disease. See the CKS topic on Coeliac disease for more information.
  • Creatine kinase (CK) — to assess for a neuromuscular cause if there is muscle tenderness or weakness. A low CK level may suggest severe disease or very low physical activity levels.
  • Bone chemistry calcium and phosphate — to assess for metabolic bone disease. See the CKS topic on Hypercalcaemia for more information.
  • Urine pregnancy test (if appropriate) and urinalysis for protein and blood — to assess for renal tract infection, inflammation, or malignancy.
• Consider arranging additional investigations to exclude other diagnoses, depending on clinical judgement:
  
  • Vitamin D level — if the person is at risk of deficiency. See the CKS topic on Vitamin D deficiency in adults - treatment and prevention for more information.
  • Vitamin B12 and folate levels — if there is macrocytic anaemia, for example. See the CKS topic on Anaemia - B12 and folate deficiency for more information.
  • Viral serology and other tests — if there is a history of infection, the person is at risk, and/or there is a possibility of other latent infection, such as toxoplasmosis, Epstein-Barr virus, or cytomegalovirus. See the CKS topics on Hepatitis B, Hepatitis C, HIV infection and AIDS, Infectious mononucleosis (glandular fever),  Lyme disease, and Tuberculosis for more information.
  • 9am cortisol level — to exclude adrenal insufficiency. See the CKS topic on Addison's disease for more information.
  • N-terminal pro-B-type natriuretic peptide level (NT-pro-BNP) — to assess the likelihood of heart failure. See the CKS topic on Heart failure - chronic for more information.

What is the differential diagnosis?

• Common underlying causes of fatigue include the following. This list is not exhaustive.
  • Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). See the CKS topic on Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) for more information.
  • Obstructive sleep apnoea. See the CKS topic on Obstructive sleep apnoea syndrome for more information.
  • Sleep disorders such as hypersomnia or narcolepsy. See the CKS topic on Insomnia for more information.
  • Rheumatological disease such as rheumatoid arthritis, psoriatic arthropathy, or systemic lupus erythematosus. See the CKS topics on Rheumatoid arthritis and Spondyloarthritis and psoriatic arthropathy for more information.
  • Cardiac disease such as arrhythmias, cardiomyopathy, heart failure, valvular heart disease. See the CKS topics on Heart failure - chronic and Palpitations for more information.
  • Respiratory disease such as severe chronic obstructive pulmonary disease. See the CKS topic on Chronic obstructive pulmonary disease for more information.
  • Renal disease such as end-stage kidney disease. See the CKS topic on Chronic kidney disease for more information.
  • Haematological disease such as anaemia, vitamin B12 deficiency, haemachromatosis. See the CKS topics on Anaemia - iron deficiency, Anaemia - B12 and folate deficiency, and Jaundice in adults for more information.
  • Hypermobility spectrum disorder and fibromyalgia. See the CKS topic on Chronic pain for more information.
  • Mental health conditions such as anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder. See the CKS topics on Depression, Generalized anxiety disorder, and Post-traumatic stress disorder for more information.
  • Neurodiversity such as attention deficit hyperactivity disorder (ADHD). See the CKS topic on Attention deficit hyperactivity disorder for more information.
  • Primary endocrine disorders such as Addison's disease, diabetes mellitus, thyroid disease, or other pituitary disorders. See the CKS topics on Addison's disease, Diabetes - type 1, Diabetes - type 2, Hyperthyroidism, and Hypothyroidism for more information.
  • Drug adverse effects or substance misuse, such as opiate use. See the CKS topic on Opioid dependence for more information.
• Specific clinical features or red flags that may indicate a potentially serious or life-threatening underlying condition include:
  • Significant unintentional weight loss (5% of body weight over 6–12 months) may suggest malignancy, Addison's disease, diabetes mellitus, or hyperthyroidism. See the CKS topics on Addison's disease, Diabetes - type 1, and Hyperthyroidism for more information.
  • Fever, night sweats, lymphadenopathy, and/or persistently elevated inflammatory markers may suggest a haematological malignancy or an infection, such as acute hepatitis, HIV, syphilis, or active tuberculosis. See the CKS topics on HIV infection and AIDS, Hepatitis B, Hepatitis C, Syphilis, and Tuberculosis for more information.
  • Muscle or joint pain may suggest inflammatory joint disease, vasculitis, or connective tissue disease. See the CKS topics on Giant cell arteritis, Polymyalgia rheumatica, and Rheumatoid arthritis for more information.
  • Localizing or focal neurological signs may suggest a neurological condition, such as brain tumour, stroke, Parkinson's disease, myaesthenia gravis, or multiple sclerosis. See the CKS topics on Brain and central nervous system cancers - recognition and referral, Multiple sclerosis, Parkinson's disease, and Stroke and TIA for more information.
  • History of travel, insect or tick bites, and skin rash may suggest tropical infection or Lyme disease. See the CKS topic on Lyme disease for more information.

Scenario: Management of tiredness/fatigue in adults

From age 18 years onwards.

Search strategy

Scope of search

A literature search was conducted for guidelines and systematic reviews on primary care evaluation and management of tiredness/fatigue in adults, and the initial presentation/management of people with chronic fatigue syndrome (CFS). 

Search dates

January 2020 - March 2025

Key search terms

The terms listed below are the core search terms that were used for EBSCOhost MEDLINE (searched 7th October 2019, update searches completed 28th January 2020). These were combined with filters to identify guidelines, systematic reviews and primary care relevant literature in EBSCOhost MEDLINE. The strategy was adapted for The Cochrane Library databases. 

S5    S1 OR S2 OR S3 OR S4 
S4    AB ( fatigue* or tired* or letharg* or TATT or CFS or myalgic encephalomyelitis or myalgic encephalopathy ) OR TI ( fatigue* or tired* or letharg* or TATT or CFS or myalgic encephalomyelitis or myalgic encephalopathy ) 
S3    (MH "Lethargy") 
S2    (MH "Fatigue Syndrome, Chronic") 
S1    (MH "Fatigue+") 

Sources of guidelines

• National Institute for Health and Care Excellence (NICE)
• Scottish Intercollegiate Guidelines Network (SIGN)
• Royal College of Physicians
• Royal College of General Practitioners
• Royal College of Nursing
• NICE Evidence
• World Health Organization
• Guidelines International Network
• TRIP database
• Agency for Healthcare Research and Quality
• National Health and Medical Research Council (Australia)
• Royal Australian College of General Practitioners
• British Columbia Medical Association
• Canadian Medical Association
• Alberta Medical Association
• Michigan Quality Improvement Consortium
• Singapore Ministry of Health
• National Resource for Infection Control
• RefHELP NHS Lothian Referral Guidelines
• Medline (with guideline filter)
• Driver and Vehicle Licensing Agency
• NHS Health at Work (occupational health practice)

Sources of systematic reviews and meta-analyses

• The Cochrane Library:
  • Systematic reviews
  • Protocols
  • Database of Abstracts of Reviews of Effects
• Medline (with systematic review filter)
• EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

• NIHR Health Technology Assessment programme
• The Cochrane Library:
  • NHS Economic Evaluations
  • Health Technology Assessments
• Canadian Agency for Drugs and Technologies in Health
• International Network of Agencies for Health Technology Assessment

Sources of randomized controlled trials

• The Cochrane Library:
  • Central Register of Controlled Trials
• Medline (with randomized controlled trial filter)
• EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

• Drug and Therapeutics Bulletin
• TRIP database
• Central Services Agency COMPASS Therapeutic Notes

Sources of national policy

• Department of Health
• Health Management Information Consortium (HMIC)

Patient experiences

• Healthtalk
• BMJ - Patient Journeys

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

• British National Formulary (BNF)
• electronic Medicines Compendium (eMC)
• European Medicines Agency (EMEA)
• Medicines and Healthcare products Regulatory Agency (MHRA)
• REPROTOX
• Scottish Medicines Consortium
• Stockley's Drug Interactions
• TERIS
• TOXBASE
• Micromedex
• UK Medicines Information

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

• Clinical accuracy.
• Consistency with other providers of clinical knowledge for primary care.
• Accuracy of implementation of national guidance (in particular NICE guidelines).
• Usability.

Principles of the consultation process

• The process is inclusive and any individual may participate.
• To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
• Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
• Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
• External reviewers are not paid for commenting on the draft topics.
• Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
• All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
• All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

• Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
• Stakeholders identified from the following groups are invited to review draft topics:
  • Experts in the topic area.
  • Professional organizations and societies (for example, Royal Colleges).
  • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
  • Guideline development groups where the topic is an implementation of a guideline.
  • The British National Formulary team.
  • The editorial team that develop MeReC Publications.
• Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

• Topic selection
• Scoping of topic
• Selection of clinical scenarios
• First draft internal review
• Second draft internal review
• External review
• Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

• Animal studies
• Original research is not written in English

Possible exclusions for reviewed literature:

• Sample size too small or study underpowered
• Bias evident or promotional literature
• Population not relevant
• Intervention/treatment not relevant
• Outcomes not relevant
• Outcomes have no clear evidence of clinical effectiveness
• Setting not relevant
• Not relevant to UK
• Incorrect study type
• Review article
• Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

• Feasibility
  • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
• Organizational and Financial Impact Analysis
• Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
  • Eligible population
  • Current interventions
  • Likely uptake of new intervention or recommendation
  • Cost of the current or new intervention mix
  • Impact on other costs
  • Condition-related costs
  • In-direct costs and service impacts
  • Time dependencies
• Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

• Personal financial interests
• Personal family interest
• Personal non-financial interest
• Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.