Liver Disease in Primary Care with Dr Helen Jarvis

In this first edition of ‘Spotlight on research’, Dr Mike Harrison (NIHR Doctoral Research Fellow) sat down to have a chat with Dr Helen Jarvis about her recent work. Helen is an NIHR GP Clinical Lecturer at Newcastle University. Her research interests relate to liver disease in primary care. She is passionate about finding the best ways to diagnose and manage liver disease within primary care. She recently chaired a global commission published in the Lancet Gastroenterology and Hepatology. Clinically, she works as a GP in Bellingham, Northumberland.

Mike: Hi Helen, thanks for agreeing to have a chat with me. So, you recently chaired a global commission on liver disease. Tell me more about this?

Helen: I was invited to chair a Global Commission for The Lancet Gastroenterology & Hepatology exploring how primary care can better respond to the global liver disease burden. It was a three-year project bringing together experts from across North America, Europe, Asia and Australasia, including primary care clinicians, hepatologists, public health specialists and allied health professionals. Our aim was to develop practical recommendations on how primary care can support liver health across the whole pathway—from prevention and early detection through to managing conditions such as viral hepatitis, MASLD (Metabolic-dysfunction Associated Steatotic Liver Disease), alcohol-related liver disease, cirrhosis and end-stage disease. The Commission was launched at the WONCA Europe Conference in Paris. Chairing this work has been a real career highlight and aligns closely with my research focus on improving liver disease pathways and making liver care a routine part of primary care.

Mike: Congratulations, this sounds like a real achievement! And what were the main findings in your report relevant to UK primary care?

Helen: One of the key recommendations from the Commission is that liver disease should be recognised as part of the wider non-communicable disease agenda, alongside conditions like cardiovascular, metabolic and kidney disease. In practice, this means integrating liver health into existing long-term condition reviews rather than creating separate pathways. We need to move away from a reactive approach, where we’re just responding to abnormal liver blood tests that come in for various reasons, and instead make liver health a proactive part of routine primary care. For patients at higher risk—such as those with type 2 diabetes, metabolic risk factors or harmful alcohol use—we should be using simple tools like the Fib-4 score to identify people who may need further assessment. This should be supported by better integration of automated tools within electronic health records to make the process easier for primary care teams. We also need clearer referral pathways between primary and secondary care, alongside better access to lifestyle support, alcohol interventions and emerging treatments.

Mike: And are there any other challenges faced regarding diagnosing liver disease in primary care?

Helen: One of the challenges is that we often talk about “liver function tests”, but those blood tests don’t actually tell us how well the liver is working. By the time liver tests become deranged, significant damage may already have occurred. We need to focus more on identifying liver fibrosis earlier using tools like Fib-4 scores, ELF tests and FibroScan.

The problem is that many of these tools are not consistently available or widely used in primary care. Some GPs may not even know they exist or how to access them. We have the technology, but we need better systems and support to embed these tools into routine care. Improving access to diagnostics in primary care could make a real difference.

A key reason for improving early detection is that we now have new treatments emerging that specifically target liver fibrosis. This changes the conversation because identifying liver disease earlier gives us opportunities to intervene, offer lifestyle support, and potentially use medications that can slow or even reverse liver damage. But when these treatments become available, it’s really important that the people who need them most can access them. With liver disease, that often means reaching people from more marginalised groups who may not come to their GP and say, ‘I’m worried I’m at risk of liver disease because I drink heavily, I’m overweight, or I have type 2 diabetes.’ We need to make sure our systems are proactive in finding and supporting those people.”

Mike: And, finally, why do you think researching primary care hepatology is so important?

Helen: One of the biggest issues for me is the gap between someone presenting to hospital with advanced liver disease and the fact that primary care may have had little involvement beforehand. Often, there have been missed opportunities for earlier intervention.

With rising rates of alcohol-related and metabolic liver disease, we need to recognise liver disease as a major public health issue. Primary care has a crucial role within this.

We also need to challenge the stigma around liver disease, particularly alcohol-related liver disease. These are people who need support, not judgement. Liver disease is a health condition influenced by multiple factors, and our health systems should focus on creating opportunities for prevention, treatment and better outcomes for everyone.

Mike: Thanks for the chat, Helen. It’s been really interesting.

Helen’s report published in the Lancet can be viewed HERE.

Reach out to Helen at: Helen.Jarvis2@newcastle.ac.uk

Last modified: Tue, 25 Aug 2026 11:10:39 BST