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.

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.

We have mapped the legacy CCGs against the new ICS boundaries in England. You can see the situation in your area by clicking on the relevant image below.

We are urging every ICS or equivalent body in the devolved nations to put a formal pathway in place for the early detection and management of liver disease across the entirety of their ICS region. This should cover alcohol related liver disease, non-alcohol related fatty liver disease (NAFLD) and viral hepatitis as-well as including pro-active case finding of those most at risk.

Full Pathways need to include:

• The existence of a best practice pathway for the interpretation of abnormal liver blood tests, assessment of fibrosis where appropriate, and the management of patients (including referral to secondary care when necessary)
• A proactive approach to identifying individuals at high risk of liver disease and undertaking a liver disease assessment with these patients
• A universal approach rolled out across your ICS or Health Board
• Once green, the full pathways thereafter need continued monitoring, auditing and to be fully evaluated for progress

We are asking supporters to ask their MP to write to their ICS or devolved body to demand change. You can write to your MP here.

If you are an MP and would like a template letter to send to your ICS please email charlotte.berry@britishlivertrust.org.uk.

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:

• To find out the situation in your area and write to your MP visit here: Help our campaign to make the early diagnosis of liver disease routine - British Liver Trust
• 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 – click here to Email your MP
• Raise awareness in parliament using our petition – sign our petition here
• Highlight best practice