This work began not as a service redesign, but as a research project: the Scarred Liver Project. From the start, patients played an active role, asking why tools capable of detecting liver disease early were used in research but not routine care? If the tools existed, why were people still being diagnosed so late? This question became the turning point.
In the UK, 50% of patients are first diagnosed with cirrhosis following an emergency admission from the complications of liver failure – resulting in a reduced quality of life, a poor prognosis and expensive associated healthcare costs
NICE Shared Learning Awards 2019
Using research evidence, the team moved from observation to action. Instead of waiting for patients to present unwell, they proactively identified those at higher risk, notably people with harmful alcohol use, diabetes and obesity, and offered full liver diagnostics through a neighbourhood working approach in community settings rather than hospitals.
Hospital specialists had to work differently. They stepped outside traditional referral pathways, partnering with GP practices and Primary Care Networks. The project allowed GPs direct access to specialist tests. Secondary care became something that came to patients, embedded within neighbourhoods and bringing specialist expertise to where it was most needed.
None of it was scary, not painful, if the GP said go to hospital that would have scared me I would have started panicking… I didn’t know much about Liver health – it has been wonderful…
Early results showed the impact. In a population of 25,000 adults, 3,688 people were identified as at risk, and around one in five of those tested already had liver disease and no prior diagnosis, including 39 with advanced cirrhosis who had no symptoms.
Expanding across four Primary Care Networks, covering 224,330 adults, the pathway identified 5,138 at-risk patients, with 2,396 attending community assessment. Of those assessed, 11.5% had significant liver damage and 2.9% cirrhosis, many living in the most deprived areas. For most, disease was caught early enough that lifestyle changes and support could prevent progression.
I am in a household of seven and the only one earning so people like me don’t have time to be ill… probably would not have gone to the hospital as you think of hospitals for emergencies or accidents…
Today, this NHS-led neighbourhood working model shows how hospital specialists and primary care can work as equal partners, using local data to detect liver disease earlier, reduce inequalities, and shift care from crisis to prevention.
Read more about the Scarred Liver Project here
