What is the ‘Make early diagnosis routine’ project?
The project aims to:
- Better understand existing patient pathways for liver disease detection and management
- Influence commissioning so that every area has an effective pathway commissioned
- Involve secondary care clinicians so that there are better partnerships across the liver disease pathway
We know that there is widespread variation in the identification, treatment and management of chronic liver disease in primary care. Anecdotally, we know that there are pockets of good practice but that there are also many areas that do not have a consistent approach to testing for and treating chronic liver disease.
Stage 1: Surveying the current status of primary care commissioning
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
Stage 2: The results: primary care liver disease pathways in the UK
The British Liver Trust has mapped the results of its survey. Areas which reported not having any 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 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.
Red: No commissioned pathway
Amber: Partial pathway or pathway in development
Green: Full Pathway in place
Black: Did not respond
Stage 3: Integrating our work into the new NHS planning
We want to drive change by influencing the commissioning of liver detection, management and care at a primary care level. Ultimately, we believe that every area should have an effective liver detection and management pathway. We want to turn our map green.
Since undertaking the survey the commissioning landscape 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 begun across England. ICS boundaries cover a much greater area than CCGs, so the ICS development will result in a smaller number of bodies, with the final total expected to be around 40 (compared with 135 CCGs).
The new ICS approach in 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
- Map the existing CCGs using the new Integrated Care System boundaries – you can see an example here.
- 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 firstname.lastname@example.org
- 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 – let us know if you would be willing to write to your MP
- Raise awareness in parliament using our petition – sign our petition here
- Highlight best practice
Exemplar pathways to help planning and commissioning
Innovation and best practice in primary care should be shared to enable widespread uptake of proven strategies for early detection. Our website features a number of exemplar pathways, as well as a financial case for action.
These documents and a host of other resources for primary care can be found here: https://britishlivertrust.org.uk/health-professionals/our-work-with-primary-care/#toolkit
How to help
If you are a patient or supporter, look out for our upcoming campaign when we will be contacting parliamentarians – add your voice to strengthen our case. Sign up here.
If you are a primary care clinician, we need you to champion the cause of liver disease. We want to work alongside you and support the improvement of early detection outcomes. Let us know that you’re willing to help by emailing here.
If you are a secondary care clinician, your expertise is crucial. Many of the areas with the most developed pathways are as a result of close collaboration and support between primary and secondary care. Let us know that you’re willing to help by emailing here.
If you are an MP and are willing to write to your ICS please email us here.