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Introduction The global burden of liver cirrhosis continues to rise and NICE recommends 6-monthly hepatocellular carcinoma (HCC) surveillance. This has resulted in increasing demand within our trust. To address this, we implemented a nurse-led cirrhosis surveillance clinic (NCSC) supported by an agreed standard operating protocol (SOP) and aimed to evaluate its safety and cost-effectiveness given the limited existing data.Methods We established a trust-wide database identifying 1,101 cirrhosis patients. Of these, 747 patients required HCC surveillance, the remainder were excluded (died, relocated, poor performance status). 244 patients were referred to the NCSC according to SOP triage from Sept 2024 to Dec 2025, alternating 6-monthly between consultant and nurse review to reduce median waiting time of consultant follow-up (12 months). We analysed demographic variables, clinical characteristics, safety profile and cost-effectiveness; costing was based on 2024 Personal Social Services Research Unit (PSSRU) estimates (consultant follow-up £52.33 per visit, Band 7 nurse follow-up £36.50 per visit).Results Analysis of 244 patients referred to NCSC:Demographics 1) Gender: male (n=171), female (n=73); 2) Age (years): mean 58.6, median 59, range 37–84.Clinical characteristics 1) Liver disease aetiology: alcohol-related (61.9%), non-alcohol (38.1%); 2) Child-Pugh score: mean 5.49, median 5, range 5–10 (Class: A (n=207), B (n=27), C (n=1), n/a (n=9)), 84.8% (207/244) met the SOP criteria; 3) Model for End-Stage Liver Disease (MELD) score: mean 9.10, median 8, range 6–24.Safety profile 1) Interval to subsequent surveillance clinic (months): mean 5.12 (95% CI 4.63–5.61), median 5 (IQR 2–7), compared to a historical median of 12 months prior to NCSC implementation; 2) Urgent escalation to consultant clinic: 11/244 patients (4.5%) due to unplanned hospital admission or disease progression; 3) Non-attendance (DNA) rate: Total of 558 appointments were scheduled for 244 patients, of which 105 appointments resulted in DNA. The DNA rate was significantly higher for nurse-led appointments (26.9% [88/326]) compared to consultant-led appointments (7.3% [17/232]) (χ2(1)=34.32, p<0.0001).Cost-effectiveness Nurse-led follow-ups for 244 patients cost £8,906 compared to £12,768.52 if they were consultant-led, resulting in an estimated gross saving of £3,862.52.Conclusion Our NCSC predominantly comprised male, middle-aged cohort with alcohol-related compensated cirrhosis. The patients referred to this clinic were safely managed mostly in compliance with our local SOP, enabling a timely HCC review within 6 months, with appropriate escalation when required and delivered measurable cost savings to the trust. However, the DNA rate in nurse-led clinics is higher than consultant clinics, which requires further review and targeted engagement strategies.