Liver disease is the fifth largest cause of mortality in England, after heart disease, cancer, stroke and respiratory disease. Of this ‘big five’, liver disease is the only major cause of death that is rising year on year, and it affects people at a younger age. It is also becoming clear that chronic hepatitis B infection is making an increasing contribution to the rising death toll from liver disease. Recently published NICE guidelines now give practice nurses and GPs a key role in the initial assessment and onward referral of patients to specialist services, and their subsequent care.
