Make early diagnosis of liver disease routine

The British Liver Trust, as part of the ‘Make early diagnosis routine’ project surveyed the status of planning and commissioning for the early detection of and management of liver disease across Clinical Commissioning Groups (CCGs) in England and equivalent bodies in Wales, Northern Ireland and Scotland.
Questions in the survey evaluated structures and processes in place relating to liver disease detection and management. Within each CCG and health board we collected data regarding:

• The presence of a named person with responsibility for liver disease
• The existence of a pathway for interpreting abnormal liver blood tests
• Whether pathways were delivered in line with published national guidelines
• Whether fibrosis assessment was included in pathways, and if so, how it was assessed
• The existence of a pathway to proactively case-find individuals who may be at high-risk of liver disease, and if so, how individuals were defined and identified

The British Liver Trust has mapped the results of its survey and published the results in the British Journal of General Practice in 2021.

Areas which reported not having any early detection pathway in place are red, those which had a partial pathway or a pathway in development are amber and those with a fully commissioned pathway that included both case-finding those at risk and properly assessing patients for fibrosis are green. Our aim is to involve supporters, local secondary and primary care clinicians, MPs, healthcare stakeholders and the newly formed Integrated Care Systems and turn this map green.

Key

• Red: No commissioned pathway
• Amber: Partial pathway or pathway in development
• Green: Full Pathway in place
• Black: Did not respond

We are driving change by influencing the provision of liver detection, management and care at a primary care level. Ultimately, we believe that ever area should have an effective liver detection and management pathway. We want to turn our map green.

Since undertaking the survey, the commissioning landscape in England has changed. The NHS Long Term plan route map envisages health and care ‘joined up locally around people’s needs’. As part of this development, Integrated care Services (ICS) formation has taken place across England. ICS boundaries cover a much greater area than CCGs, so the ICS development will has resulted in a smaller number of bodies (42 new ICSs compared with 135 CCGs). The boundaries in Scotland, Wales and Northern Ireland have remained the same.

In 2023, we conducted a resurvey of all 42 newly formed Integrated Care Systems and existing health boards in the devolved nations.

Please find below a map that shows the responses to the survey.

Key

• Red: No commissioned pathway
• Amber: Partial pathway or pathway in development
• Dark Amber: Pathway available but not consistent across the whole area
• Green: Full Pathway in place
• Black: Did not respond

Due to the change in commissioning structures in England, we have developed a new category for classification of status - dark amber meaning pathway available but not consistent across the whole area. This was used to represent several ICS areas which have pathways in place that are still aligned to old CCG or hospital trust catchment areas which form part of the ICS but have yet to be taken on and rolled out across the entire ICS area.

The new ICS approach offers a number of opportunities for the British Liver Trust to influence the commissioning of care, not least due to the significantly smaller number of bodies.

The next stage of our work is to:

• Share the results of our survey with each ICS, public health director and legislator to raise awareness of the postcode lottery that liver disease patients face across the UK
• Undertake media work to raise awareness of the situation in each area – targeting underperforming areas – get in touch if you would like to help by being a media case study by emailing media@britishlivertrust.org.uk
• Work with lead secondary care clinicians and target each ICS asking them to improve care, highlighting best practice
• Engage MPs across the country to influence care in their region
• Highlight best practice