Working in partnership with the British Liver Trust, the RCGP has identified liver disease as a clinical priority with the aims of improving the detection and management of risk factors for liver disease and diagnosing liver disease early to reduce progression to cirrhosis, liver cancer and end-stage liver disease.
NICE guidance on liver disease
NAFLD. NICE guideline 49 was published in July 2016, and provides guidance on the identification of adults, young people and children with non alcohol-related fatty liver disease (NAFLD) and those with NAFLD who have advanced liver fibrosis and who are at risk of further complications. It outlines lifestyle changes and pharmacological treatments for this area. TEN TOP TIPS for NICE Guideline 49 - a digestible summary of the guidance
Cirrhosis. NICE guideline 50 covers the assessment and management of suspected or confirmed cirrhosis in people who are 16 years or older. It aims to improve how cirrhosis is identified and diagnosed. It recommends tools to assess the severity of cirrhosis and gives advice on monitoring people with cirrhosis to detect and manage complications early, and referral criteria for tertiary care. TEN TOP TIPS for NICE Guideline 50 - a digestible summary of the guidance
See a Clinical News article by Clinical Champion Dr Jez Thompson summarising the NICE guidelines 49 & 50.
Physical complications of alcohol use disorders. NICE clinical guidance 100 was published in 2010 and covers key areas in the investigation and management of the following alcohol-related conditions in adults and young people (aged 10 years and older) including alcohol-related liver disease.
Hepatitis B infection. The diagnosis and management of chronic hepatitis B infection in children, adults and young people is covered by NICE clinical guidance 165.
Hepatitis B and C testing. In 2012 NICE published public health guideline 43 on hepatitis B and C testing; people at risk of infection. The guidance covers awareness-raising; developing the knowledge and skills of healthcare professionals and others providing services for people at increased risk of hepatitis B or C infection; testing for hepatitis B and C in a range of setting; contact tracing; neonatal hepatitis B vaccination; and commissioning treatment and laboratory services.
RCGP clinical priorities
The college has identified a number of clinical priority areas, and further details of this programme can be found here.
Each programme has developed its own resource page, and areas of particular crossover relevance to liver disease include:
RCGP e-learning in liver health
The RCGP offers a certificate course in the Detection, Diagnosis and Management of Hepatitis B and C in Primary Care, providing a basic grounding for primary care staff in issues around hepatitis B and C. This course consists of a compulsory e-learning module followed by a face to face training day which is facilitated by an approved RCGP trainer. Participants are awarded with a certificate upon successful completion of both the e-learning and training.
Lancet Commission on Liver Disease
The Lancet Commission on Liver Disease has the aim of improving the care for those with liver disease and reducing the burden of liver-related morbidity and premature mortality by providing the strongest evidence base through involvement of experts from a wide cross-section of disciplines. The commission has published two strategic documents, both of which are downloadable.
Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. The Lancet November 2014.
Implementation of the Lancet Standing Commission on Liver Disease in the UK. The Lancet November 2015.
CLDF’s Yellow Alert Awareness Campaign promotes the crucial early diagnosis of liver disease in newly born infants so that appropriate and timely referrals can be made. A range of resources is available from the Foundation:
Links to liver-disease related organisations
British Liver Trust. The British Liver Trust is the leading UK liver disease charity for adults, providing information and support for professionals, patients and carer; promoting prevention and early diagnosis of liver disease; funding and championing research and campaigning for better services. The Trust works with smaller diagnosis specific patient organisations and has links to all of these on it’s website. In addition the Trust has an anonymous liver health screener that assesses the risks of alcohol, obesity and viral hepatitis and provides a useful print out of what you need to do and if need be what to discuss with your GP.
Children’s Liver Disease Foundation. The CLDF is a UK-wide charity that provides support, information research funds and a voice for all those affected by childhood liver disease.
Yellow Alert. is CLDF’s prolonged jaundice in newborn babies awareness campaign. Yellow Alert promotes the early diagnosis and appropriate referral for liver disease in newly born infants.
Alcohol Concern. Alcohol Concern’s aims to help people concerned about their drinking by providing information and guidance, and to help professionals through training, projects and research.
Drinkline. Drinkline provides a national helpline to offer help and signposting for callers worried about their drinking, support for the family and friends of people who are drinking and links to information and self-help materials.
Alcohol Health Alliance. The Alcohol Health Alliance brings together more than 40 organisations that have a shared interest in reducing the damage caused to health by alcohol. Members include medical royal colleges, charities, patient representatives and alcohol health campaigners. Its aims are to highlight the rising levels of alcohol-related harm; propose evidence-based solutions to address the harms; and influence decision makers to take positive action.
Obesity Health Alliance. The Obesity Health Alliance is a coalition of over 30 organisations who have joined together to fight obesity. Members include medical royal colleges, charities, campaigners and professional associations. We work together to influence Government policy on overweight and obesity.
Hepatitis C Trust. The Hepatitis C Trust is a national UK charity supporting those with hepatitis C infection. It is a patient-led and patient-run organisation and most of its board, staff, and volunteers either have hepatitis C or have had it and have cleared it after treatment.
Hepatitis B positive. This organisation provides information for the public on hepatitis B infection.
Hepatitis Scotland. Hepatitis Scotland provides training for non-statutory organisations, information and support for patient involvement for those with hepatitis B or C infection in Scotland, and resources for health professionals.
British Association for the Study of the Liver. BASL is a multidisciplinary association with 850 members from medical, nursing and research backgrounds. It aims to advance knowledge about liver biology and pathology; disseminate research findings and promote clinical care of liver disease.
British Liver Nurses Forum. The Forum is for nurses from all clinical areas and departments who seek to promote and develop the care of patients with liver disease. The Forum holds one national conference each year, and publishes twice yearly newsletters. In collaboration with the Royal College of Nursing and other stakeholders the Forum has developed robust clinical competence framework.