| Description | Prof PHILIP HANNAFORD interview at the Sir Duncan Rice Library, University of Aberdeen on Wednesday November 23, 2022. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) PHILIP CHRISTOPHER HANNAFORD, born 1 July 1958 in Lewisham, London. Retired in August 2020 as Professor of Primary Care at the University of Aberdeen. Father a policeman, mother did clerical work. Has an older and a younger brother. Parents divorced when Phil was about 13, mother continued to live with him and youngest brother, older brother went to live with father. Mother’s sister moved from London to Aberdeen, when Phil about 15 moved with his mum and Kevin his younger brother to Aberdeen, living with his Auntie Jean and Uncle Ray. Had been at Chislehurst and Sidcup Grammar School, but in Aberdeen attended Rubislaw Academy (subsequently returned to its original name, Aberdeen Grammar School, in the late 1970s). Credits TV programmes like "Doctor On The Go" and "Dr Kildare" for interesting him in medicine as a career, explains. Started medical studies in Aberdeen, comments on his school exam qualifications not being particularly good for medicine; explains how he worked for Fraser’s department store in Aberdeen, went on their management course, then got call saying place for him to study medicine starting almost immediately in Aberdeen. Initially disappointed, explains. But had great time studying medicine for five years in Aberdeen, starting in 1976. (0:04:21) Talks about life then as a medical student, standards different then, explains. Recalls anatomy at the Drain, at Marischal College, etc. Remembers lecturer in Physiology who pulled him up for plagiarising another student’s practical work. Recalls coming into his first contact with patients, on to wards for first time, excitement and trepidation. (0:07:58) Explains his medical career in Aberdeen after graduation in 1981. Met his wife in medical school, got married six days before they graduated. Had decided they would not get married till they could be together for their House job, did this in Aberdeen, Phil on "the City rotation", explains what this involved. Then moved to Dumfries for their surgical house officers’ job, for six months. Phil then got on to Sheffield vocational training scheme, explains what they did for next three years in Sheffield. His wife Anne got on to psychiatry training scheme in Manchester, explains how this worked while he was finishing his training in Aberdeen, then moved to Manchester, explains. (0:10:46) Explains how he went into general practice by "a slightly odd route" - explains in detail, RCGP (Royal College of General Practitioners). Mentions writing to Clifford Kay, director of the Manchester research unit, and getting research job for a year. But told his wife it was on the Pill (contraceptive pill), how boring! Towards end of that year, Clifford told him they would really like to keep him on. Clifford had been running massive study since 1968 on the contraceptive pill, and he wanted help with this, Phil explains he had honorary title with the University of Manchester. This was in mid-1980s. (0:14:33) In August 1986 becomes Principal in General Practice at Manchester, explains how this came about. So he was a part time principal in general practice, and a part time research fellow in the RCGP Manchester Research Unit, with an honorary lectureship at Manchester University. Did that for a number of years. Stopped being a principal in 1992, at time of Kenneth Clarke’s (government minister for Health) changes in General Practice, explains. Took decision at end of 1992 to become full time researcher in the research unit. (0:17:15) Goes through rest of his career up to the point he came back to Aberdeen; research studies on contraception and abortion; other projects included one with SmithKline Beecham (pharmaceutical company) on heart attacks, explains in detail, thrombolytic, a clot-buster drug previously only used in hospitals, research into safety of GPs using it. Clifford Kay retired from research unit in 1994. Phil continued as director of the RCGP research unit in Manchester till he came to Aberdeen. Funding becoming increasingly precarious, explains consequences, unit to be closed, so Phil applied for position in Primary Care in Aberdeen and got the job. Explains how well what he had been doing in Manchester fitted with Primary Care, and how his work on health data helped him understand how GPs work. General Practice then was the gatekeeper to hospital care, GP record was a good basis for epidemiological work. Very attracted to that type of data. (0:21:47) Job attracted him to Aberdeen because he had come to the city to do some work with the Dept of Public Health, Cairns Smith was the professor at that time, explains in detail about this work in context of his interest in Manchester in pre-eclampsia; Cairns Smith, Doris Campbell, himself and others made application to British Heart Foundation to use the Aberdeen Maternity and Neonatal Databank for research into affect of pre-eclampsia on women’s health in later life. So had worked with colleagues in Aberdeen, attracted to the fact could do epidemiological work here. Primary care going through a boom time, explains. Number of universities recruiting specialised professors rather than traditional professor of general practice. His predecessor Sir Lewis Ritchie (as he is now) persuaded Grampian Health Board to fund a research chair in primary care, post he came to. (0:25:16) Explains difference between General Practice and Primary Care. Nowadays much bigger team, though doctor still central; he thinks of GP as the specialist of normality, explains. Other clinicians around; nurses, occupational therapists, pharmacists. Because that team not medically trained can’t say it’s just general practice, hence term used is primary care. When he moved to Aberdeen department was known as the Department of General Practice and Primary Care. Over time title changed to Primary Care, some controversy, explains. (0:27:42) Explains what Primary Care Dept was like when he arrived there in 1997 to take up Chair. Nurses, small clinical trials unit, strong pharmacy group - lot of the work being led by Christine Bond and Ross Taylor. There was a non-clinical Sociologist. Traditional model then of average practice, describes. Then describes how speciality of Primary Care developed in Aberdeen during his 23-year tenure. Thinks slightly imploding at the moment, larger practices, broader team providing the care, explains in detail, number of different models emerging of how care can be provided. Lack of health care professionals worldwide, particularly acute in Aberdeen, challenges. (0:32:31) Explains challenges faced by Primary Care in Aberdeen when he arrived in 1997, and what he did about them - need to both focus and expand. Departmental team was small then, Lewis Ritchie was head, explains. Describes how much of his time spent between NHS and academia. He saw patients face to face very little, explains why in detail. Talks about other bodies outside Aberdeen University that he has done work for; research grant committees, Chief Scientist’s office, World Health Organization, etc. Strange career, based in primary care department but often looked at public health issues. (0:38:54) Started career in Aberdeen with academic work, but developed over the years into more managerial roles, explains it was an unplanned career. Started in 1994, Research Assessment Exercise (RAE) across UK, now called REF (Research Excellence Framework). Joined primary care panel of RAE, explains in detail about what this involved for him. Locally involved in Aberdeen’s submission, nationally involved as part of the panel. Came up with idea, along with colleagues of Institute of Applied Health Sciences, in Aberdeen, a virtual organisation bringing together a number of public health, epidemiological or community-facing disciplines to focus and boost our research activities, explains why. Initially led by Cairns Smith, describes individual departments and units involved. Phil found he quite enjoyed this sort of work, so when Cairns chose to set down as director, he took over and then took on more managerial roles within the university, ended up as a vice-principal, explains. (0:43:39) Talks through a typical day in his role as NHS Professor of Primary Care. There wasn’t a typical day! Explains in detail, a lot of academia is committee work. Describes in detail how hard it was to keep abreast of medical developments while doing managerial work. Quite lucky to sit on national committees; e.g. one of funding bodies of the Medical Research Council, also one of funding committees Cancer Research UK, WHO (World Health Organization). They keep you abreast of current thinking of different specialities, helped. Regrets not having more direct contact with patients, and as a department, not having GPs more heavily involved, explains why. (0:49:25) Talks about golden period for the department for about ten years between late 1980s and late 1990s, explains why in detail. National competition for another chair of Primary Care Respiratory Medicine, Aberdeen won out over favoured candidate Dundee, mentions input of secondary care colleagues Dr James Friend and Joe Legge. Got the money, then couldn’t get someone to fill the post, describes what happened. Talks of success in funding training fellowships. Department grew, and was very strong, but difficult to sustain, explains why and what happened. Talks of working closely with Christine Bond, projects looking at role of pharmacists in community care. Did lot of work with Blair Smith, Alison Elliot and Cairns Smith, and Alistair Chambers, the NHS consultant in anaesthetics, lot of work round epidemiology of pain and chronic pain. Also worked with Neil Campbell, on models of care for cardio-vascular patients and models of care for cancer patients. Worked for last 20 years with research fellow Lisa Iversen on effect of oral contraception on women’s health, and other female health-related issues. (0:54:49) Explains about Epidemiology, which a colleague once described as having tracked him throughout his career; defines it as study of the causes and frequency of disease in the community. Technique now being used to look at other health care-related issues, explains. In context of general practice, explains. Can now do epidemiological research on computer records. Refers to his original work on oral contraception study looking at whether the Pill is associated with different types of cancer, explains about more recent study with colleagues in Denmark looking at newer pills. Would say he is a primary care epidemiologist. (0:58:22) Talks in detail about his other role as an Honorary Consultant in Public Health Medicine in Aberdeen. Explains how this role came about, in detail, "a bit of foresight" of a colleague. Explains about the contract arrangements for clinical academics. (1:02:37) Explains in detail about how, having early in his career thought that research on oral contraception was boring, he came to specialise in research in that very area. Epidemiology a detective story. Also gripped by the contraceptive pill because so much data was available for research. Refers to his work with the WHO, sometimes having to make public health decisions about contraception on very uncertain data. Gives example - is there a connection between hormonal contraceptives, particularly the injectable drug Depo (Depo-Provera) and an increased risk of HIV? Answers this, contrast between situation in UK and South Africa etc. Has really enjoyed doing this sort of work. (1:07:42) Refers to his decision to retire in 2020, not COVID-related, explains why. Talks about his research fellow Lisa Iversen and having a conversation about what he felt was a very odd virus in China. Explains he offered his services to analyse data re COVID, did not happen. But did get involved with Oxford University research involving clinical trials into COVID treatments. Also involved with the Medicines Health Agency - Yellow Card reports on whether COVID vaccines affect women’s health outcomes. (1:10:43) Asked about other roles he undertook, how they fitted in with his main work. Pays tribute to Lisa Iversen, Research Fellow in Dept of General Practice. Between them managed to do a lot of research together, explains how this worked. Talks about the importance of Aberdeen in the development of Primary Care as a speciality. In late 1990s to about 2010, strongest department of Primary Care in Scotland, made serious academic contributions to primary care more widely in the UK. As time has gone on, possibly because Phil was more involved with management, department has shrunk again. Explains why in context of both Aberdeen, and clinical academia in general - not affecting just Primary Care. Hard to be a clinical academic now. (1:15:12) Achievements of Dept of Primary Care? Thinks his continuing research into safety of contraception had a major contribution to science. He and his colleagues were developing the concept of Primary Care Epidemiology, explains they defined this in published form. Pharmacy work in Aberdeen has been recognised as having a major impact. Also chronic pain work highly cited, highly influential. (ENDS 1:17:20)
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