Table 1 participating sites (Sites C, E and F are described in more detail in the text)

A (England)

GP-led clinic with a core MDT including nurse, physio, OT, psych

Patients referred by GPs have an initial telephone assessment, usually nurse-led. Follow up appointments are virtual by default, although home visits can be arranged. Some patients are selected for review at the MDT, where a suggested plan for investigation/ management/ onward referral) is made and forwarded to the patient’s GP

7 MDTs (7 h, 17 patients)

2 clinics (5 h); 3 patients

20 patients aged 30–62

B (Wales)

Hospital-based clinic run by respiratory consultant and clinical research fellow

Accepts referrals from primary and secondary care. All referrals triaged by consultant. No formal MDT support but input available on request from community-based rehabilitation team. Most initial consults are face-to-face with follow ups virtual or face-to-face, based on need

3 MDTs (3 h, 22 patients)

Not visited

22 patients aged 30–62

C (England)

Community clinic, physically based in community health offices but run virtually. Led jointly by GP and OT, with physio, psych and MH. Wider MDT includes SALT and dietician

Patients referred by GPs have a 60–90-min telephone or video consultation with GP or OT. GP (with MDT input) makes decisions about further investigation or onward referral but there is no facility for patients to be assessed in-person by the long covid team

5 MDTs (7 h, 37 patients)

1 clinic (6 h); 5 patients

42 patients aged 21–81

D (Scotland)

Hospital clinic led by clinical psychologist with support from infectious disease consultant. MDT also includes GP, physio, OT

Because clinic serves a wide geographical area, most patients have a video or telephone consultation; there is a small capacity for in-person clinic reviews. Much ongoing support is virtual

5 MDTs (8 h, 54 patients)

Not visited

54 patients aged 18–70

E (England)

Hospital clinic based in chest and allergy outpatients. Set up by a respiratory consultant with interest in long covid but now multiple consultants rotate. With OT, physio, psych

Primarily an assessment service. Patients referred by GP are seen in person by 4 MDT members in turn; each case is discussed briefly before and after clinic. Good integration and pathways with community rehab services. Local services include specialist POTS clinic based in cardiology

2 MDTs (2 h, 15 patients)

1 clinic (7 h); 5 patients

20 patients aged 25–73

F (England)

Large rehabilitation service linked to a teaching hospital and university. Community (OT-led) clinic with physio, OT, psych, therapy assistants, dieticians. Close links to consultant-led clinic based in hospital rehabilitation unit

Community tier takes GP referrals and links with community-based rehab in a local leisure centre. Well-established referral links and pathways for cardiology, respiratory, neurology, and sleep services as well as local mental health and well-being services

3 MDTs (3 h, 17 patients)

2 clinics (7 h); 7 patients

24 patients aged 18–68

G (England)

Large hospital service based in respiratory outpatients in teaching hospital. Consultant-led with nurse practitioner support, plus large MDT including OT, physio, psych

Patients referred by GP have 60-min telephone assessment by nurse practitioner before seeing doctor in-person. Doctor orders further tests and refers on to other specialties and programs

9 MDTs (6 h, 30 patients)

2 clinics (8 h); 10 patients

40 patients aged 34–87

H (England)

Consultant-led clinic in large teaching hospital and university, originally established by respiratory consultant. Also, separate specialist POTS clinic run by cardiologist with special interest

At the time of the study, patients had a one-stop holistic assessment with input from medics, psych, physio and specialist lung function tests. Direct links into secondary care referral systems and a specialist rehab team. In September 2023 the clinic was remodeled; it now runs under infectious diseases with a focus on CFS/ME, with support from a specialist nurse

2 tier 4 MDTs (2 h, 13 patients)

2 clinics (8 h); 7 patients

20 patients aged 18–69

I (England)

Based in rehabilitation outpatients on a large hospital campus with strong research links. Led jointly by rehabilitation and respiratory consultants, with MDT including OT, physio, SEM, psych, MH

Patients referred by GP are seen by consultant for 40-min face-to-face assessment before seeing allied professionals who refer on to rehab programs. Allied health professionals include specialist pulmonary rehab physios, OTs with interest in ME/CFS, and community psychological support services

2 MDTs (3 h, 19 patients)

2 clinics (8 h); 9 patients

28 patients aged 26–72

J (England)

Multi-tier system across a large urbanized geographical area. Hospital tier is led by respiratory consultant with physio, OT, psych, MH, and rehabilitation medicine. Region-wide (tier 4) MDT includes endocrinology, cardiology, neurology, psychiatry and occupational health

Patients referred by GPs are seen in GP-led clinic, which offers in-person holistic assessment, management and rehabilitation. Selected cases are taken to the secondary care MDT (for consultant opinion) or the region-wide MDT (complex cases discussed by multiple specialists)

4 tier 3 MDTs (3 h, 11 patients) plus 3 tier 4 MDTs (5 h, 9 patients)

1 clinic (5 h); 4 patients

24 patients aged 25–71

TOTAL

45 MDTs (49 h, 244 patients)

13 clinics (54 h, 50 patients)

45 MDTs, 13 clinics (104 h, 294 patients)