We aim to help patients and their doctors to identify the condition, and then offer support to manage it as effectively as possible.

We can help to reduce some of the symptoms using medication and other approaches, but many people face the challenge of living with these ongoing symptoms for some time. We know that ME/CFS can gradually improve in many people, and the support that we offer can increase the likelihood of progress. We also know that learning ways to manage the condition can help people to make improvements in quality of life. For example, many patients experience a delayed increase in symptoms a day or two after an increase in activity levels. This is known medically as “post-exertional malaise” but it is known to many of our patients as “payback”. This delayed response can make the illness particularly difficult to manage. Through learning self-management skills, people can reduce the likelihood and severity of this “payback”. This can provide a more stable situation which allows some patients to slowly build up important activities.

What happens when you first visit the Bristol M.E. service?

We accept referrals from GPs and hospital specialists. Once we have checked the appropriate tests have been completed by your GP, you will be sent some questionnaires to fill in: these form the basis of the initial assessment. We send them to you so that you have a chance to think about the questions before the appointment, so hopefully the appointment is not so demanding. The appointment will be with one of the team: a psychologist, physiotherapist or occupational therapist who will discuss your symptoms and the impact of your symptoms on your day to day to life. During this appointment we may diagnose ME/CFS, but sometimes it is necessary to make a second appointment.

Following diagnosis, a management plan is agreed: often this can include a further individual appointment or taking part in one of our multidisciplinary therapy groups. Our Service offers a multidisciplinary approach, in line with the NICE guidelines. We regularly monitor newly published research into ME/CFS, but at present there are a limited number of evidence-based treatments for ME/CFS. Three guides to therapies have been produced by the British Association of Clinicians in ME/CFS (BACME). There is a guide to symptom management, a guide to therapy and also a guide offering advice for people who are severely affected by ME/CFS To find out more about these guides, visit https://bacme.info/

We often see people who have developed M.E./CFS following an infection, such as glandular fever. Other people can identify a period of stress leading up to the start of their illness. A combination of infection and stress is also common. Occasionally, it starts without an obvious trigger.

Researchers are gradually developing insights into how the condition develops and the changes which take place in the body as a result of illness. However, this picture is far from complete at present.

A more detailed summary of the current evidence can be found at the Centers for Disease Control and Prevention website www.cdc.gov/me-cfs/about/possible-causes.html

There is been a gradual increase in research into M.E./CFS over the years, especially in the past decade. Some of this research was looking for a single "broken part", as is common with medical research. It's a bit like taking your car to the garage: you expect them to find out what's wrong, take the broken part out and fix it. This approach has led to some insights but more recently researchers have been looking at the behaviour of systems in the body and finding that they don't behave normally, particularly after an exercise challenge. This shift of focus in the research is likely to be more helpful. It's more like having a problem with a modern car, taking it to the garage, and finding that they identify a problem with the software which is stopping it from running smoothly. You can find a webinar delivered by the British Association for Clinicians in M.E. (BACME) which puts together a lot of these ideas in this Youtube video.

Consultant Plastic Surgeons at NBT

Miss Rachel Clancy

Mr Thomas Chapman

Miss Giulia Colavitti

Mr Thomas Wright

Consultant Oncologists at UHBW

Dr Gareth Ayre

Dr Adam Dangoor

Dr Timothy Spencer

Clinical Nurse Specialists

Christine Millman

Rebecca Peach

Sally Lovell

Consultant Radiologists

Dr Brathanban (Ben) Rajayogeswaran

Dr Edward Walton

Extended Core Members North Bristol NHS Trust (Urology)

Mr Salah Albuhessi

Mr Ahmed Mahrous

University Hospital Bristol and Weston NHS Foundation Trust (Thoracics)

Miss Eveline Internullo

Mr Doug West

Consultant Histopathologists

Dr Naomi Carson

Dr Francesca Maggiani

Dr Demetris Poyiatzis

Sarcoma Cancer Support Worker

Hannah Hilton

Patient Pathway Coordinators

Charlotte Brown (Plastic Surgery)

Lisa Groves (Plastic Surgery)

Gemma Flook (Urology)

MDT Coordinator

Amy Dixon

Cancer information session

Cancer Support Worker

Macmillan Wellbeing Centre

Bristol Haematology and Oncology Centre (BHOC)

Cancer Research UK

My Medical Record

Penny Brohn

Patient information leaflets

Can-Empower

© North Bristol NHS Trust. This edition published January 2025. Review due January 2028. NBT003764

British Association of Spine Surgeons, visit www.spinesurgeons.ac.uk

British Scoliosis Society, visit www.britscoliosissoc.org.uk

Eurospine, visit www.eurospine.org

The Scoliosis Research Society, visit www.srs.org

AO Spine, visit www.aospine.org

The Bristol Neurological & Spinal Unit provides a Clinical Fellowship for up to one year for a senior surgical trainee wishing to pursue a career in spinal surgery. 

Previous Spinal Fellows have come from either a Neurosurgical or Orthopaedic background. 

There are also opportunities for both UK and international fellows to visit the respective departments of Orthopaedics or Neurosurgery to gain further experience within these sub-specialties. 

For further information regarding the Senior Clinical Spinal Fellowship please contact Mr John Hutchinson Consultant Orthopaedic Surgeon on Mr Nitin Patel.

The Bristol Neurological & Spinal Unit has a strong reputation for innovation and groundbreaking research in relation to spinal conditions. Examples of clinical research include:

•  Development and evaluation of new instrumentation to treat paediatric spinal deformity
• Motion preserving spinal technologies such as cervical disc replacements
• Image guided spinal surgery
• Minimally invasive spinal surgery
• Neuro-modulation for chronic pain 
• Investigations into the causes of adult onset spinal deformity

The Bristol Neurological & Spinal Unit also has strong research links with the University of Bristol Department of Anatomy, University of the West of England, the University of Bath Department of Biomechanical Engineering, as well as close links with the Bristol Institute of Clinical Neurosciences.

A comprehensive range of spinal interventions can be undertaken at the Bristol Spinal Unit:

• Emergency spinal surgery for spinal trauma, cauda equina syndrome and tumours
• Intradural spinal micro-neurosurgery
• Diagnostic and therapeutic spinal nerve root blocks
• Spinal deformity surgery including Adult and Paediatric Scoliosis
• Degenerative Cervical and Lumbar deformity surgery
• Minimally invasive and micro-spinal surgery
• Non-instrumented and instrumented spinal surgery for degenerative conditions
• Percutaneous vertebroplasty and kyphoplasty
• Imaging guided spinal tumour biopsy service
• Spinal cord stimulation service for complex regional pain
• Congenital Spinal Pathology including paediatric spinal dysraphism surgery
• Spinal vascular microsurgery
• Inflammatory spinal conditions such as rheumatoid arthritis

At the Bristol Neurological & Spinal Unit, based at Southmead Hospital Bristol we provide a high quality service not just from the technical aspects of what can be achieved but also quality from the perspective of the patient.

The Orthopaedic Spine Surgeons are at the forefront of collecting data on clinical quality outcomes and Neurosurgery are developing tools for recording patient reported outcomes.

As part of our quality agenda the majority of our elective patients are seen at a pre-assessment clinic to identify any potential risks that could influence surgery. The pre-operative assessment clinic is run by specialist nurses under the leadership of surgical and anaesthetic consultants. The nurses help patients prepare for their operations, anticipated discharge home and also provide information regarding what to expect during the recovery period. This all contributes to a smoother in-patient experience for patients.

There are Consultants leading the Audit and Clinical Governance programmes within the Bristol Neurological and Spinal Unit. The specialist nurse practitioners conduct telephone follow up interviews for patients who have undergone non-complex “routine” spinal surgery. We have an active policy of monitoring for surgical site infection and this service is again delivered by our specialist nurse practitioners.

Both the Neurosurgical and Orthopaedic Spinal Teams hold multi-disciplinary team meetings. This provides a forum for discussing patients with challenging spinal conditions as well as an opportunity to reflect on the service and plan for future developments, to present audits and to discuss research proposals. 

The Bristol Spinal Unit accepts patients referred from Primary Care Teams as well as Regional Inter-Hospital referrals as well as national and international referrals. 

We offer a full range of operative and non-operative management strategies for patients with spinal conditions.

Bristol Bariatric Service (BBS) offers primary and revision bariatric surgery (including laparoscopic gastric band, gastric bypass and sleeve gastrectomy). We have an established unit since 2003 and have funding for approximately 250 primary operations per year.
Bariatric Surgery can be considered as a possible treatment option for people with obesity when:

• BMI >40 kg/m2 or person with BMI 35-40 kg/m2 who has other significant disease that could be improved if they lost weight (e.g. type 2 diabetes, hypertension, dyslipidaemia, obstructive sleep apnoea, Benign Intracranial Hypertension etc.).
• All appropriate non-surgical measures have been tried but the person has not achieved or maintained adequate, clinically beneficial weight loss.
• The person has been receiving or will receive intensive management in a Tier 3 service (WAMS).
• The person is generally fit for anaesthesia and surgery.
• The person commits to the need for long term follow up.
• Bariatric surgery is the option of choice (instead of lifestyle interventions or drug treatment) for adults with a BMI of > 50 kg/m2 when other interventions have not been effective.
• Patients with a BMI >35 kg/m2 who have recent-onset type 2 diabetes should be offered an expedited assessment for bariatric surgery as long as they are also receiving or will receive assessment in a Tier 3 service (WAMS).
• Consider an assessment for bariatric surgery for people with BMI 30-35 kg/m2 who have recent onset type 2 diabetes as long as they are also receiving or will receive assessment in a Tier 3 service (WAMS).
• Consider an assessment for bariatric surgery for people of Asian family origin who have recent onset type 2 diabetes at a lower BMI than other populations as long as they are also receiving or will receive assessment in a Tier 3 service (WAMS).

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We will endeavour to assess, investigate and treat patients as soon as possible, and keep you fully informed of their progress.

We accept referrals from:

• Primary care via letter detailing BMI and co morbidities. 
• Interprovider

These should be sent to:

Pauline Clifford, Obesity Services Coordinator
Office 2, Gate 38, Level 3, Brunel building
Southmead Hospital, Westbury‐on‐Trym, Bristol. BS10 5NB
Telephone: 0117 414 0855 or 0117 414 0854

Advice & Guidance

Clinical Advice:
Bariatric Specialist Nurse, Faye Taylor
Telephone 0117 4147557 or 0755 7312784 (Monday-Friday).

Administration or Referral Advice:
Pauline Clifford
Email: pauline.clifford@nbt.nhs.uk (Monday to Wednesday) 
Telephone:0117 414 0855 or 0117 414 0854