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Hepatology Clinical Assessment Service (CAS)

All referrals from primary care and internal referrals go through our Hepatology CAS service, designed to streamline the process by pre-loading first patient contact with diagnostic tests, to facilitate more rapid diagnosis, decision making and management plans. The service involves a virtual appointment in which hepatology consultant, CAS specialist nurse and patient pathway coordinator assess referrals, decide on investigations, and communicate with the patient and referrer.  This does not involve an appointment at this stage to which the patient is expected to attend. More information on the service is available within the Hepatology CAS leaflet (please click the Hepatology CAS link under Factsheets and Useful Links).

Community Fatty Liver Pathway

The community fatty liver pathway is an evidence-based algorithmic process, being adopted by all CCGs within Southwest London, to risk stratify patients with non-alcoholic fatty liver (disease) according to their risk of liver fibrosis, the presence of which is associated with liver related and cardiovascular outcomes. The pathway uses the FIB-4 index (requiring the patients, age, a full blood count and liver function tests including an AST) as the first modality, followed by the Enhanced Liver Fibrosis (ELF) test in intermediate cases. Please include FIB-4 index +/- ELF test result, in addition to alcohol history, within the referral. The pathway is depicted below alongside the pathway for the investigation of abnormal liver function tests in primary care (click on links below). Whilst cases are assessed individually, absence of FIB-4 index +/- ELF may result in a request to provide this information prior to the patient being seen.

Viral Hepatitis

We are happy to receive referrals for patients with hepatitis B and C into the hospital, via the CAS service. We also run a range of hepatitis clinics in community locations including drug and alcohol services in the six boroughs of South West London and HMP Wandsworth. Key workers can make direct referrals to our staff in these locations. In 2022 we started a community clinic in a specially adapted minibus for testing and treatment of viral hepatitis. We also run community Fibroscan screening for liver fibrosis and cirrhosis as part of an NHS England funded pilot for the early detection of liver cancer.


We conduct transient elastography (Fibroscan) as a non-invasive method of fibrosis assessment. Patients are selected based on clinical information provided and always occur alongside a clinical evaluation. We do not perform Fibroscans as isolated diagnostic service and only take referrals within our catchment area. Patients should fast prior to their Fibroscan appointment. Please click on the Hepatology CAS investigations link under Factsheets and Useful Links for more information on Fibroscan.

South West London CCG Protocol for Diagnosis and Referral of Non-Alcoholic Fatty Liver Disease (PDF)

Guidance for the Initial Management of Abnormal Liver Function Tests (PDF)