RCGP refuses to change their classification of CFS as a mental health disorder

Back in April The MEA wrote to the Royal College of General Practitioners (RCGP) to ask them to change their decision to classify CFS as a mental health disorder in an important training document for GPs:  Care of People with Mental Health Problems. We have now received a very disappointing reply.

The MEA has written back to the RCGP to ask them once again to change this inaccurate classification.

The exchange of correspondence is set out below:

1  Original MEA letter dated 2 April

2  RCGP reply dated 15 May

3  MEA response dated 29 May

RCGP curriculum publication ‘Care of People with Mental Health Problems’ 


1 Original MEA letter dated 2 April

Dear Professor Field


The ME Association would be grateful if you could explain why the Royal College of General Practitioners has decided to classify CFS as a mental health disorder in your publication ‘RCGP Curriculum Statement 13: Care of People with Mental Health Problems’


The current WHO classification for ME and PVFS is in section G93:3 of ICD10 – the neurological disease section.  CFS is indexed to this G93:3 classification.


The UK Department of Health has made it clear that they accept this classification, as did Ann Keen (Parliamentary Under-Secretary for Health Services at the Department of Health) when she spoke to the ME All Party Parliamentary Group at the House of Commons on 22 January 2008.


I would also point out that the Read Code for CFS is F286 (F is used to denote nervous system diseases) and that Read Codes for mental health disorders start with the letter E.  None of the other ‘mental health disorders in primary care’ listed in Appendix 3 of the Curriculum Statement have a code starting with F.


Yours sincerely


Dr Charles Shepherd

Hon Medical Adviser, The ME Association


4 Top Angel


MK18 1TH

(This letter was sent to Professor Steve Field, Chairman of Council at the Royal College, and passed on for reply to Dr Bill Reith, chairman of the RCGP Postgraduate Training Board.)

2 RCGP reply dated 15 May

Dear Dr Shepherd

Chronic Fatigue Syndrome in the RCGP Curriculum

I appreciate the interest that you have shown in the curriculum for speciality training for general practice. Clearly chronic fatigue synrome is a condition of sufficient importance to be included in the curriculum.

The group that developed the curriculum were aware of the difficulties of assigning this condition to a specific grouping and eventually elected to include it within the statement on ‘Care of People with Mental Health Problems’. It was a difficult decision but it was taken largely on the grounds that many specialist services are currentlyl configured and based in, or are linked to, psychology services. No assumptions should be drawn from this about the college’s views on causality.

In reaching their decision, the group also took into account the NICE guideline for CFS/ME which states:

‘Many different potential aetilogies for CFS/ME – including neurological, endocrine, immunological, genetic, psychiatric and infectious – have been investigated, the diverse nature of the symptoms can not yet be fully explained. The World Health Organization (WHO) classifies CFS/ME as a neurological illness (G93.3), and some members of the Guideline Development Group (GDG) felt that, until research further identifies its aetiology and pathogenesis, the guidelines should recognise this classification. Others felt that to do so did not reflect the nature of the illness, and risked restricting research into the causes, mechanisms and future treatments for CFS/ME.’

In the same way as medicine develops and changes as new evidence is identified, so the GP training curriculum will develop and change. In the process of any such review, it seems likely that CFS will continue to be included within the curriculum and any new evidence as to its causation and treatment will be incorporated.

The curriculum is currenrtly in the process of being reviewed in order to submit updates to the Postgraduate Medical Education and Training Board, which has to approve any changes. I will ensure that your comments are taken into account during that process.

Dr Bill Reith

Chairman, Postgraduate Training Board

Royal College of General Practitioners

14 Princes Gate

Hyde Park

London SW7 1PU

 3 MEA response dated 29 May

Dear Dr Reith
Thank you for your letter dated 15 May.
I have discussed this RCGP response with MEA trustees and we all agree that it is completely unacceptable.
Firstly, it fails to deal with the key point that we raised regarding Appendix 3 on page 20 (Mental health disorders in Primary Care, with Read codes): 
The Read code for CFS is F286 and F codes are only used for neurological disorders. Read codes for mental health disorders start with the letter E.  You cannot therefore include a Read code F neurological disorder in a list of E code mental health disorders.  CFS must, therefore, be removed from the list in Appendix 3.
Secondly, it makes no sense whatsoever to claim that you can classify an illness as a mental health disorder simply because some patients are being seen in departments of psychiatry or psychology within the NHS. 
Thirdly, we do not understand how you can state that ‘In reaching their decision, the group also took into account the NICE guideline for CFS/ME…’  On page 5 it states that the RCGP document was ‘Created: December 2004’ and ‘Date of this update: February 2006’.  The NICE guidance was published in August 2007.  How can the group have taken the NICE guideline into consideration when it wasn’t even published at the time?
I am sure you must appreciate the problems that are being caused to people with ME/CFS, including ones involving denial of benefits and insurance cover/payments, and the failure to obtain or continue with employment, when their illness is inaccurately classified by a doctor as being a mental health disorder – as the RCGP is clearly doing in this training document.  This can obviously result in considerable financial loss and we are aware of people taking legal action as a result of inaccurate classification of their illness.
We are not, therefore, prepared to let this matter rest.
If the RCGP is not prepared to reverse the decision to inaccurately classify CFS as a mental health disorder, we will raise our concerns with the All Party Parliamentary Group on ME when they next meet at the House of Commons.
Yours Sincerely
Dr Charles Shepherd
Hon Medical Adviser, The ME Association
7 Apollo Office Court
Radclive Road
Bucks MK18 4DF



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