If, following Step 2 of the All-Wales Abnormal Liver Blood Test pathway, the diagnosis is still not clear or there is still clinical suspicion of liver disease, a referral to Hepatology Services is still appropriate. The Liver aetiological screen and fibrosis risk assessment tools will not identify all patients with significant liver disease, and therefore this step is necessary if the patient raises an index of suspicion to get a second opinion from the secondary care Hepatology teams.