Obituary: Dr John Callander

DURING AN acutely difficult period, in the late 1980s and early 1990s, when most general practitioners opposed the Government's contract proposals, John Callander chaired the Conference of Local Medical Committees which, meeting at the headquarters of the British Medical Association in London, constituted a parliament for general practice.

Changes, initiated and orchestrated by Margaret Thatcher's government, were creating maximum controversy in the profession. Callander's Glasgow University Medical School friend and contemporary Dr Sandy Macara, the future Chairman of the BMA, 1993-98, says of him:

The significant thing about John was that he created no enemies. At the sharp end of medical politics, this was unusual, to say the least. He could disarm people in a reasonable way, and unlike many a "reasonable" man, could do it with charm, tact and without infuriating colleagues.

Skilful, much sought after and compromising chairman that he was of many BMA and Scottish BMA Committees, Callander held passionate and uncompromising views about the National Health Service, to which he exclusively devoted his working life. Callander never did have a private patient. And, professionally he was top-class, as my family and I can testify since we were his patients for 35 years.

On his mother's side, John Callander came from a family of sea captains, many of whom sailed from the Firth of Forth. He took pride in his role of one of the Keepers of the "Sea-Chest" - a charitable fund in the 10,000- population town of Bo'ness on the Forth, in the Middle Ages the second busiest port in Scotland, to which he was to devote 40 years of professional practice and where he was much loved.

The "Sea-Chest" was created in 1635, when a ship from Bo'ness was captured by Turkish pirates. Some sailors were murdered; others were taken prisoners and had their thumbs cut off. To help the dependants, skippers of other ships from the south side of the Forth decided to put 10 per cent of their trading profits into a sea-chest. The 50 members of the society who are annuitants of the fund claim that it is the oldest Registered Friendly Society in Britain. The original chest is in the Bo'ness museum, which owes much of its development to Bo'ness Heritage, of which Callander was a senior committee member. For 360 years it has had two locks with a different key, so that both Keepers or Guardians have to be present whenever it is opened. John Callander, as a doctor, was one Guardian: his colleague for some years has been Colin Cuthell, the well-known central Scotland undertaker: "One to take it out and the other to put it in," as the local wags felicitously put it.

In my 30 years as the town's MP, not a single complaint, or whisper of a complaint, came to me about either Callander or the practice of which he was senior partner. One reason for harmony in the view of his colleague, Dr John Park, was that even during the times of his greatest number of absences in Edinburgh and London doing the business of the BMA, he was meticulous about doing his fair share of day and night duty. Another reason was that he generously acknowledged that partners such as the late Dr Angus Leys and Dr Tom Sargent were more talented diagnosticians of rare conditions than he was. And he was good.

Callander's father was a master joiner in Glasgow. At pounds 2 per term, he sent his son to the Corporation-run Hillhead High School - the school for boys, many of modest means, which produced two chairmen of ICI, Sir Harry McGowan and Sir Alexander Fleck, Sir Ian McGregor of British Steel and the Coal Board, the Vice-Chancellors Sir Charles Wilson and George McNicol, Sir John Rennie of the UN Relief and Works Agency, the ambassador Sir Horace Phillips, the newspaper editor Sir Alistair Dunnett, to say nothing of the politician Menzies Campbell QC MP and the comedian Stanley Baxter, and instilled the ethics of extraordinarily hard work into pupils.

More particularly for Callander were three role models in medicine, Professor Eldred Wright the anatomist, Professor Jack Dunnett the medical crystallographer and Ian Gillespie, the surgeon. He acknowledged the role of devoted schoolteachers at Hillhead in giving him the confidence as a working-class boy to do medicine, and was interested in making sure that the medical profession should be open to all regardless of means in boyhood and during their time as students.

At Glasgow University, like his lifelong medical friend Dr Dickson Mabon, later a prominent minister in the Wilson and Callaghan governments, he came under the influence of the distinguished physiologist Professor George Wishart, Charles Illingworth, a pioneering surgeon, Stanley Alstead, Professor of Therapeutics, and Ian Donald, Professor of Obstetrics and a medical engineer who developed ultrasound as a diagnostic tool. "At first, we thought Donald was very strange," said Callander, "rattling his primitive iron bars in order to diagnose the condition of ill patients. Later we realised that he was a genius."

Callander's first job was at Port William in Wigtownshire, from 1954 to 1956. This short period left an indelible mark of understanding of the problems facing the deeply rural GP whose cause he was to champion as a member, and subsequently chairman, of the Rural Practices Sub-Committee of the General Medical Council of Scotland and at BMA House in London. The obligation of night visits to remote farmsteads and hamlets without a doctor ought to be recognised.

Callander also helped to enhance the interest of his BMA colleagues in addressing the all too frequent injuries to agricultural and forestry workers. An accident in the Glen Trool Forest in the first few weeks of his first job made him determined to promote the need for urgent skilled medical attention to be provided in outlying areas. He extolled the value of the small cottage hospital.

In 1956 he moved, partly out of a romantic respect for his seafaring ancestors, to Bo'ness, then the mining town of the huge Kinneil Colliery whose seams stretched under the Forth, and became the junior partner of Hugh Howieson, an experienced doctor and leading authority on pneumoconiosis, silicosis, and emphysema, the curse maladies of coal-miners. Much moved by having to tend in their homes elderly, and not so elderly, ex-miners who did not have the breath to go up their own staircases, Callander campaigned inside the BMA for more generous diagnosis of miners' chest complaints, in favour of identification of pneumoconiosis and silicosis, which brought a meagre compensation - as against no compensation at all for chronic bronchitis, often an indistinguishable illness.

On Howieson's retirement in 1958 Callander attracted as his junior colleague Angus Leys, a brilliant diagnostician who was to die tragically young. Soon the practice expanded to half a dozen doctors. His experience was translated into a fervent belief in 24-hour cover by the practice itself, in contrast to centrally organised cover in one form or another by a Health Authority. "Patients are entitled in emergency," contended Callander, "to be seen by one of their own practice: if not by their own doctor, at least a doctor with easy access to case notes".

Callander's first taste for UK medical politics was whetted when I asked him to meet the then Secretary of State for Health Richard Crossman, whose PPS I was when he came to Scotland. The Crossman diaries for November 1968 recall:

They [and the most articulate - as I was present - was John Callander] gathered round me and told me all about merit awards. This was the way Nye Bevan got the consultants to back him, so that he could stand out against the BMA when the NHS was originally founded. The promise of merit awards bought them, with the condition that though the total sums and the subjects are published the names are not. It has been a kind of old- boy arrangement for consultants and has caused the keenest resentment from both the GPs and the young consultants. I came down to London full of the idea that we should either end the system or publish the names but it seems crystal clear that, though this is the right thing to do, I will only do it after a row royal with the colleges and many of the leading consultants. It is the kind of quarrel one ought not to go into without careful calculation.

Weeks later I was present again at a ministerial meeting when Crossman quoted word for word what Callander had told him in Scotland to surgeons led by the formidable Walpole Lewin and Sir John Richardson (who had saved Crossman's life in North Africa), who were less than pleased about the views of the young doctor regurgitated to them by the Secretary of State. When I told Callander what had happened at this august meeting at Elephant & Castle, the then headquarters of the Department of Health, he characteristically chuckled.

Callander stepped into the breach as Chairman of the Scottish Council of the BMA when Dr Matthew Armstrong left to take up a position in London. Sandy Macara remembers: "John was a brilliant success. The only person who could not believe that he was a great success was John himself." He was a success because he championed the rights of the individual patient to be treated as an individual rather than to be the subject of target payments designed on a group basis. He saw a patient as an individual man or woman and thought group solutions simply devalued and demeaned the individual patient.

He was profoundly concerned about the consequences of fund-holding. He feared that decisions would be taken on occasions not on the basis of the needs of the patient but on account of a doctor's assessment as to how it would affect the funds of the practice. He was genuinely reluctant to condemn colleagues because he understood that good people faced with many expensive cases in less advantaged areas would understandably begin to fret about where the money was coming from.

He believed furiously in the paramount importance of the clinical judgement of the doctor, which should not be affected by the state of funding. He died deeply concerned about the future of the NHS to which he had devoted his life.

John Callander, medical practitioner: born Glasgow 25 June 1931; married 1955 Joy MacDonald (one son, two daughters); died Bo'ness, Central 7 October 1998.