Professor Willie Hamilton

About me:

Willie Hamilton is a third generation doctor from Belfast. He specialises in primary care diagnostics, with particular expertise in cancer.

Willie’s research has had a major impact on improving earlier diagnosis of cancer in the UK, which saves lives. He was clinical lead on the main NICE guidance, ‘Referral for Suspected Cancer’ NG12, published in 2015; this governs approximately £1 billion of annual NHS spending. Of the 210 NICE recommendations in NG12, 100 can be traced back in part or wholly to his publications. These new guidelines have contributed to meeting the target of reducing the number of avoidable cancer deaths in the UK by 10,000. The battle is not yet won, but patients are being diagnosed earlier, cancer survival is improving, and year on year hundreds fewer cancer patients are being diagnosed with an emergency complication of their cancer.

Willie and his team have also produced Risk Assessment Tools for all major adult cancers. These provide the GP and patient with an accurate estimate of the risk of cancer when a patient reports symptoms to their GP. These have been converted to electronic form with support from Macmillan the cancer charity. A major randomised control trial of these begins in 2019, supported by a £2 million philanthropic donation from the Dennis and Mireille Gillings Foundation. This illustrates that Willie’s research work remains deeply focussed in general practice, aiming to further improve cancer survival in the UK and internationally.

This work has been supported by grants totalling over £30 million, including an NIHR programme grant (2010-6) and another in 2020, the Department of Health-supported Policy Research unit (2010-18, renewed in 2019), the flagship Cancer Research UK Catalyst award with Cambridge, (2015-2020) and philanthropic funding from the Gillings Foundation. He received a CBE for services in improving early cancer diagnosis in the 2019 New Years Honours.

Background

Willie trained in Bristol before moving to Exeter to do hospital medicine.

After a stint in Malawi as a government physician, he returned to Exeter to train in general practice. Ten years of clinical practice followed, before he moved into academia. In 2000, he joined Bristol with two supporting fellowships: from the Royal College of GPs, and from the NCC (now NIHR). These supported his initial work into the symptoms of cancer. After obtaining his MD, he was awarded a NIHR-doctoral fellowship, allowing expansion of the cancer symptoms work. In 2010 he joined the Peninsula College of Medicine and Dentistry as Professor of primary care Diagnostics, a post he now holds in the University of Exeter Medical School. His team forms the DISCOVERY unit (DIagnosing Symptomatic Cancer Optimally - with the VERY acting to emphasise the optimally). https://medicine.exeter.ac.uk/research/healthresearch/disco/

Willie is profoundly deaf, but is driven by the mantra, ‘Deaf people can do anything except hear’. With lip reading, hearing aids and two cochlear implants (one working) he retained a successful career in clinical general practice though ceased at the end of 2016 to concentrate on his research work.

Willie follows two further mantras: his school motto, Quaerere Verum (‘to seek the truth’) and the Royal College of GPs, Cum Scientia Caritas (‘caring with science’). No Latin motto has been printed that does justice to Willie’s choice of shirts, however.

From 2017 to 2021, he leads the university’s contribution to a CRUK £4.83m flagship Catalyst Award. He is co-principal investigator with Dr Fiona Walter in Cambridge, on this award, called CanTest. The main research question within this award is the study of tests for cancer in primary care; sub–questions include; what tests can be moved safely and acceptably to primary care? What new tests work? Will GPs and patients accept the transfer of testing out of hospitals? What are the economic and safety aspects of transfer of responsibility for testing? The CanTest collaboration also has a major educational theme aimed at fostering the next generation of researchers in this key subject.

Willie is also the lead on a large randomised trial – the ERICA trial – which examines the effectiveness and cost-effectiveness of electronic clinical decision support for cancer which is integrated into GP clinical software. Supported by a £2m philanthropic donation from the Dennis and Mireille Gillings Foundation, this trial recruits practices from 2021, reporting in 2025.

Willie manages and provides leadership to the fifteen current research staff PhD students. He was also the clinical lead in the 2012-5 update of the NICE referral guidelines for suspected cancer, which influences over £1bn of NHS spending on cancer diagnosis. He has over 320 peer-reviewed publications, including winning the RCGP overall paper of the year twice.

Interests:

Willie's main research field is early diagnosis of cancer in primary care. He has produced dozens of cancer diagnostic peer-reviewed publications, plus an award winning textbook. Willie lead the Early Diagnosis Subgroup within the NCRI’s primary care clinical studies group until recently. He also holds a £2m NIHR programme grant as PI entitled ‘optimising diagnosis of symptomatic cancer’ (2010-2015) and is a founder co-applicant to the DH’s Policy Research Unit on Cancer screening, awareness and early diagnosis, funded by a £5m grant from the DH. 21 of Willie's 31 project grants are based on aspects of cancer diagnosis.

Willie has led the UK cancer diagnosis agenda for several years, and has produced charts on cancer risk that are now being used for 13 cancers in UK GP surgeries to assess risk. This work was presented in a symposium at the 2013 NCRI annual conference, which Willie chaired, and has attracted considerable media interest. The system is now being tested as software for GPs clinical computers which prompts when the risk of cancer is above 2%. The study is being funded by DH, CRUK and Macmillan.

Research grants

I have been awarded a total of 43 programme/project grants (total over £22m) as either principal or co-investigator, in addition to the NCCRCD researcher development award, the NIHR postdoctoral award and the RCGP/BUPA fellowship (fellowships total £850k as PI), plus my research practice core funding (£150k as PI).

1. Understanding the effectiveness, cost-effectiveness and current use of cancer diagnostic tools to aid decision-making in primary care. Peters, J, Lewis, R, Neal, R, Spencer A, Price S, Hamilton, W, Cooper, C. HTA £240,800. 2017-8
2. Opportunities for earlier colorectal cancer diagnosis along the diagnostic pathways: Importance of healthcare and patient-related factors. Renzi, C, Lyratzopoulos, G, Rachet, B. Hamilton, W, Coleman, M, Waller, J. BMA Gunton award. £49,978. 2016-8.
3. ‘WICKED’ (Wales Interventions and Cancer Knowledge about Early Diagnosis): The development and evaluation of primary care interventions to expedite the diagnosis of symptomatic cancer in Wales. Neal RD, Hamilton W et al, Welsh Govt £800,000, 2016-8.
4. Clinical and cost effectiveness of progressive exercise compared to best practice advice, with or without corticosteroid injection, for the treatment of rotator cuff disorders: a 2x2 factorial randomized controlled trial (GRASP). Lamb, Hopewell, Barker, Carr, Keene, Jaggi, Hamilton, Dutton, Simera, Gray, Hansen, Littlewood, Dritsaki. HTA £1,228,000 2016-9.
5. Evaluating the impact of NICE guidelines for suspected cancers in respect of diagnostic interval and other outcomes. Spencer A, Hamilton W (co-PIs), et al. CRUK. £148,000, 2016-8.
6. GW4-IF5-003 GW4 Cancer Research Consortium: Murell AM, Hamilton W, et al. GW4 Initiator Fund, 2016. £15,000
7. Enhancing the diagnostic pathway for dementia: The DECODE Project. Llewellyn, D Hamilton W, Dickins, C. Halpin Trust 2016-9. £100,000
8. Proton-Pump Inhibitor therapy: quasi-experimental evaluation of longer-term use in older patients. Ble, A, Melzer, D, Henley, W, Hamilton, W, Strain D. NIHR RfPB 2015-7. £236,891.
9. Understanding the diagnostic pathway for brain tumours in adults and its potential impact on clinical care and outcomes. Brennan, P, Grant, R, Ben Schlomo, Y, Hamilton, W, Hollingworth, W, Kurian, K, Weller D. The Brain Tumour Charity. £299,619. 2015-7.
10. Phase II exploratory randomised controlled trial (RCT) comparing use of electronic clinical decision support (eCDS) for suspected oesophago-gastric cancer in primary care with usual care. The oesophago-gastric risk evaluation (OGRE) trial. Rubin, GP, Neal, RD, Walter, FW, Emery, J, Whyte, S, Whitaker, Hamilton, W and Ukoumunne, O. CRUK 2014-6 £307,000
11. Bowel Disease In Younger Adults: Selection For Investigation In Primary Care (BODYSHOP). Hamilton, W. Shephard, E, Alsina, D, Rubin G. Policy Research Programme 2014-16. £120,000
12. Building the evidence base for the early symptomatic diagnosis of cancer (ABC-DEEP Consortium). Neal, RD, Torring ML, Stapley SA, Campbell C, Vedsted P, Wilkinson C, Hamilton W, Emery J, Rubin G, Weller, D. CRUK 2013-4 £126,337.
13. MRC APBI STratification and Extreme Response Mechanism IN Diabetes (MASTERMIND). Pearson, E, Gray A, Hamilton W, Hattersley A, Henley, W, Hyde, C, Janmohammed, S, Jennison, C, Shields, B, Weedon, M. MRC £718,070. 2013-5.
14. Development and testing of a new tool to measure the diagnostic interval in cancer research. Weller D, Walter, F, Hamilton W, Rubin, G, Neal, R, CR-UK £100,000, 2012-13.
15. Continuity And Detection Of Cancer in Primary Care (CADOC-PC). Ridd M, Salisbury C, Montgomery A, Hamilton W. CRUK. £37,308 2011-2012
16. Diagnostic intervals in cancer; baseline study and comparison before implementation of NICE guidance– database analysis. Neal RD, Rubin G, Hamilton W. Department of Health £85K. 2009-2011.
17. Long term outcome in giant cell arteritis. Luqmani R, Hutchings A, Dasgupta B, Arden N, Smeeth L, Hamilton W, Culliford D. RfPB £96,226. 2011-3.
18. El CiD: Improved lung cancer identification by targeted chest X-ray (CXR) – a clinical trial looking at the effect on lung cancer diagnosis of giving a CXR to smokers aged over 60 with chest symptoms. Neal R, Hurt C, Tod A, Rogers T, Hamilton W. CRUK, £380,000. 2011-3
19. A systematic review of the risk of cancer posed by symptoms reported to primary care, for oesophagus, stomach, uterine and cervical cancers. Hamilton W. Sharp, D, Rose P, Neal RD. CRUK, £49,323 2011-2 [principal applicant].
20. ColoRectal Early Diagnosis: Information Based Local Evaluation (CREDIBLE). Marshall T, Wilson S, Dowswell G, Morton D, Hamilton W, Greenfield S. CRUK, £323,000, 2011-3. [co-applicant]
21. Policy Research Unit in Cancer awareness, screening and early diagnosis. Duffy SW, Coleman MP, Bernard R, Sasieni P, Cusick J, Parkin M, Ramirez AJ, Wardle J, Nazareth I, Forbes L, Raine R, Macleod U, Rubin G, Hamilton W. Department of Health. £7,500,000. 2011-8. [co-applicant]
22. Optimising diagnosis of symptomatic cancer. NIHR Programme Grant. Hamilton W, Walter F, Raffle A, Emery J, Rubin G, Ades T, Bankhead C, Peters T, Knowles J, Hollinghurst S, Rose P, Brindle P, Turner K, Neal R. £1,945,945. 2010 – 2015. [principal applicant].
23. Using a participant-completed questionnaire to identify symptoms that predict lung cancer: a feasibility study. Wilson S, Brindle L, Corner J, George S, Hamilton W. NIHR School for Primary Care Research (NSPCR). £126,043 2009-11 [Primary care input to design and conduct]
24. Evaluation of symptom presentation and onward referral of young women later diagnosed with cervical cancer in England: a four part study. Hamilton W, Rubin G, Sasieni P, Ramirez A, Patnick J, Thackeray A, Poole J, Kitchener H. £42,586, 2009-10 NHS Cancer screening programme [principal applicant; design and conduct of parts 1 and 2 – the grant figure only relating to the Bristol component]
25. The role of ultrasound compared to biopsy of temporal arteries in the diagnosis and treatment of giant cell arteritis, Luqmani R, Bradburn M, Hutchings A, Wailoo A, Dasgupta B, Salmon J, Wakefield R, McNally E, Hamilton W, McDonald B, Wolfe K, NIHR HTA, £1,569,250 2009-13. [Primary care input to design and conduct]
26. Bristol homeopathic hospital costs study. Wye L, Fordham R, Thompson R, Hamilton W. Co-funded; Blackie Foundation (£22.9k) British Homeopathic Association (£10k), SW GP Trust (£10.5k), and UBHT (£12k) – total £55,000. 2009-10. [co-applicant; design lead]
27. A systematic review of risks of cancer posed by symptoms reported to primary care, Hamilton W, Rose P, Neal RD. NSPCR £46,000, 2008-9 [principal applicant; this includes some unspent monies from grant 12]
28. Determining the diagnostic accuracy of Colonix testing in patients at moderate risk of colorectal cancer. Hamilton W, Daniels I. Funded by Colonix Ltd. £172,114 2008-9. [principal applicant, on commercial grant]
29. Time to diagnosis in symptomatic cancer: does it have an effect on clinical and psychological outcomes? Systematic review, and scoping work for future research. Neal R, Lewis R, Hendry M, Wilkinson C, Russell I, Macleod U, Hamilton W, Mitchell E, Stuart N, Williams N, Belcher J, Peters T. Cancer Research UK (CRUK) £115,453 2008-9 [co-applicant; design and interpretation]
30. Iron deficiency anaemia and delayed diagnosis of colorectal cancer: a feasibility study. CRUK £33,722 2007-8. Wilson S, Ryan, R, Hamilton W, Iqbal TH, Ismael, T, Rubin G, Gratus C, Murray J, Lawrence G, Hobbs R. [co-applicant; design and interpretation]
31. Earlier diagnosis of ovarian cancer in primary care; a case-control study of symptoms, signs and investigations preceding the cancer. NSPCR. £200,000 2007-8. Hamilton W, Bankhead C Sharp D, and Peters T.[principal applicant]
32. Earlier diagnosis of metastatic cancer in primary care; a case-control study of symptoms, signs and investigations preceding the cancer. NSPCR. £100,000 2007-9. Hamilton W and Rose P. [principal applicant]
33. Caper-C; seedcorn funding to develop the CAPER score for clinical use. NSPCR £50,000. 2007. Hamilton W. [principal applicant]
34. Assessing the potential for earlier detection of colorectal cancer in primary care using the GP research database. CRUK. £56,687 2006-8. Hamilton W, Marshall T, Cheng KK, Peters TJ, Sharp D. [principal applicant]
35. Achieving earlier diagnosis of symptomatic colorectal cancer in general practice – a pilot study in 5 UK regions. Department of Health. £24,933 2005-6. Mant D, Rubin G, Hamilton W, Jiwa M, Weller D. [co-applicant; design and interpretation]
36. A randomized controlled trial of patient self-completion agenda forms on prescribing in general practice. Co-funded Medicines Partnership, East Devon and Exeter PCTs £32,500; 2004-5 Hamilton W, Russell D, Seamark D, Britten N. [principal applicant]
37. Towards earlier diagnosis of cancer in primary care; a case-control study of symptoms, signs and investigations preceding cancer. Department of Health. £222,257; 2001-3. Hamilton W, Round A, Sharp D, Peters T and Hattersley A. [principal applicant]
38. The prevalence, incidence, predictions and associations of general practitioners’ records of fatigue symptoms and syndromes in the year following infectious mononucleosis. Linbury Trust. £58,992; 2002-3. White P, Thomas J and Hamilton W. [co-applicant; design and interpretation]
39. One year incidence of GP records of fatigue related symptoms and diagnoses with a case-control study of premorbid risk factors in patients diagnosed with CFS-like diagnoses, compared with patients with IBS and patients attending for other reasons. Dept of Work and Pensions. £65,068; 2002-4. White P, Thomas J and Hamilton W. [co-applicant; design and interpretation]
40. Do community-based self-reading sphygmomanometers improve detection of hypertension? SW Region. £15,661;2001-2. Hamilton W and Round A. [principal applicant]
41. Prediction of ill-health from simple data. Assurance Medical Society. £11,525; 2001-2. Hamilton W and Hall GH. [principal applicant]

Can non-attendance at hospital outpatients be reduced by giving patients a copy of their referral letter? National R&D programme Primary/Secondary care interface. £19,432; 1996-8. Hamilton W, Round A and Sharp D. [principal applicant]

Qualifications:

2005 MD (Bristol) Thesis title: “Earlier diagnosis of colorectal, lung and prostate cancer”

2003 FRCP

2002 FRCGP

1989 MRCGP

1986 MRCP (UK)

1982 MB, ChB (Bristol)

1979 BSc (2,1) in Medical Microbiology (Bristol)

Career:

Career

Current and previous posts

2010 – present Professor of Primary Care Diagnostics, University of Exeter

2007 - 2010 Consultant Senior Lecturer, Department of Community Based Medicine, University of Bristol

1990-2001 Principal in General Practice, Barnfield Hill, Exeter

2006 - 2016 General practitioner, Mount Pleasant Health Centre, Exeter

Selected publications

Neal RD, Barham A, Bongard E, Edwards RT, Fitzgibbon J, Griffiths G, et al. Immediate chest X-ray for patients at risk of lung cancer presenting in primary care: randomised controlled feasibility trial. Br J Cancer. 2017;116:293-302.

Bailey SE, Ukoumunne OC, Shephard EA, Hamilton W. Clinical relevance of thrombocytosis in primary care: a prospective cohort study of cancer incidence using English electronic medical records and cancer registry data. Br J Gen Pract. 2017;67:405-13.

Mounce LTA, Price S, Valderas JM, Hamilton W. Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records. Br J Cancer. 2017;116:1530-43.

Stapley SA, Rubin GP, Alsina D, Shephard EA, Rutter MD, Hamilton WT. Clinical features of bowel disease in patients aged >=50 years in primary care: A large case-control study. British Journal of General Practice. 2017;67(658):e336-e44.

Torring ML, Murchie P, Hamilton W, Vedsted P, Esteva M, Lautrup M, et al. Evidence of advanced stage colorectal cancer with longer diagnostic intervals: a pooled analysis of seven primary care cohorts comprising 11720 patients in five countries. Br J Cancer. 2017;117(6):888-97.

Atkin W, Wooldrage K, Shah U, Skinner K, Brown J, Hamilton W, et al. Is whole-colon investigation by colonoscopy, computerised tomography colonography or barium enema necessary for all patients with colorectal cancer symptoms, and for which patients would flexible sigmoidoscopy suffice? A retrospective cohort study. Health Technology Assessment. 2017;21(66).

Lim AWW, Hamilton W, Hollingworth A, Stapley S, Sasieni P. Performance characteristics of visualising the cervix in symptomatic young females: a review of primary care records in females with and without cervical cancer. British Journal of General Practice. 2016;66(644):e189-e92.

Hamilton W, Walter FM, Rubin G, Neal RD. Improving early diagnosis of symptomatic cancer. Nat Rev Clin Oncol. 2016;13:740-9.

Neal RD, Tharmanathan P, France B, Din NU, Cotton S, Fallon-Ferguson J, et al. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer. 2015;112:S92–S107.

Shephard EA, Neal RD, Rose P, Walter FM, Litt EJ, Hamilton WT. Quantifying the risk of multiple myeloma from symptoms reported in primary care patients: a large case–control study using electronic records. BJGP. 2015;65(631):e106-e13.

Rose PW, Rubin G, Perera-Salazar R, Almberg SS, Barisic A, Dawes M, et al. Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey. BMJ Open. 2015;5(5).

Hamilton W, Stapley S, Campbell C, Lyratzopoulos G, Rubin G, Neal R. For which cancers might patients benefit most from expedited symptomatic diagnosis? Construction of a ranking order by a modified Delphi technique. BMC Cancer. 2015;15:820.

Banks J, Hollinghurst S, Bigwood L, Peters TJ, Walter FM, Hamilton W. Preferences for cancer investigation: a vignette-based study of primary-care attendees. The Lancet Oncology. 2014;15:232-40.

Hamilton F, Carroll R, Salisbury C, Hamilton W. The risk of cancer in primary care patients with hypercalcaemia: a cohort study using electronic records. Br J Cancer. 2014;111:1410-12.

Ades AE, Biswas M, Welton NJ, Hamilton W. Symptom lead time distribution in lung cancer: natural history and prospects for early diagnosis. International Journal of Epidemiology. 2014;43:1865-73.

Ridd M, Santos Ferreira D, Montgomery A, Salisbury C, Hamilton W. Patient-doctor continuity and diagnosis of cancer: electronic medical records study. British Journal of General Practice. 2014;65:e305-12.

Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT. Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. BJGP. 2014;64(626):e584-e9.

Dommett RM, Redaniel T, Martin RM, Stevens MCG, Hamilton W. Risk of childhood cancer with symptoms in primary care: a population-based case-control study. British Journal of General Practice. 2013;63(606):e22-e9.

Weller D, Vedsted P, Rubin G, Walter FM, Emery J, Scott S, et al. The Aarhus statement: improving design and reporting of studies on early cancer diagnosis. Br J Cancer. 2012;106(7):1262-7.

Hamilton W, Peters TJ, Bankhead C, Sharp D. Risk of ovarian cancer in women with symptoms in primary care: population based case-control study. BMJ 2009. 2009:339:b2998.

Current research grants

Duffy, SW, Sasieni, P, Offman J, Rachet B, Raine R, Waller J, Von Wagner C, Sheringham, J, Pashayan, N, Lyratzopoulos G, Walter F, Neal R, Hamilton W, Mitchell, E, Lewins D. Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Department of Health. 2018-2023. £4,997,576.00

What is the clinical-effectiveness and cost-effectiveness of embedded risk-of-cancer assessment of patients in primary care; the ERICA trial. W Hamilton, M Pitt, Anne Spencer, John Campbell, Rod Taylor, G Abel & F Warren, and S Dean. £2.75m Philanthropic donation to University of Exeter, D and M Gillings, 2018-2020

Selection of Eligible People for Lung Cancer Screening using Electronic Primary Care DaTa: Development of new risk prediction models. Baldwin, D, O’Dowd, E, Hubbard, R, de Koning, H, Field, J, Hamilton, W, Callister, M, ten Haaf, K, Janes, S. CRUK. 2018-2021, £352,945.

Enhancing the diagnostic pathway for dementia: The DECODE Project. Llewellyn D,Ballard, C, Campbell, J, Hamilton W, Dean D, Kuzma, E, Moore, S, Warren, F, Lang I. The Halpin Trust. £123,558. 2018-2020.

Guideline discordant diagnostic care: when do primary care referrals not reflect guidelines for suspected cancer. Abel G, Lyratzopoulos, G, Campbell, J, Hamilton W. CRUK, £117.089. 2018-9.

CanTest- Cancer diagnostic testing in primary care: a paradigm shift for cancer diagnosis. Hamilton W, Walter F (co-PIs), Johnson, M, Singh, H, Lyratzopoulos, G, Abel, G, Spencer, A, Thompson, M, Sutton, S, Rubin, G, Neal R, Vedsted, P, Emery J. CRUK Catalyst Award, £4,834,829. 2017-22.

Understanding the effectiveness, cost-effectiveness and current use of cancer diagnostic tools to aid decision-making in primary care. Peters, J, Lewis, R, Neal, R, Spencer A, Price S, Hamilton, W, Cooper, C. HTA £240,800. 2017-8

‘WICKED’ (Wales Interventions and Cancer Knowledge about Early Diagnosis): The development and evaluation of primary care interventions to expedite the diagnosis of symptomatic cancer in Wales. Neal RD, Hamilton W et al, Welsh Govt £800,000, 2016-8.

Clinical and cost effectiveness of progressive exercise compared to best practice advice, with or without corticosteroid injection, for the treatment of rotator cuff disorders: a 2x2 factorial randomized controlled trial (GRASP). Lamb, Hopewell, Barker, Carr, Keene, Jaggi, Hamilton, Dutton, Simera, Gray, Hansen, Littlewood, Dritsaki. HTA £1,228,000 2016-9.

Evaluating the impact of NICE guidelines for suspected cancers in respect of diagnostic interval and other outcomes. Spencer A, Hamilton W [co-PIs], et al. CRUK. £148,000, 2016-8.