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He established his practice at Newcastle upon Tyne where he developed an interest in social paediatrics, which included interests in providing adequate nutrition to children in poor families and support for [[breastfeeding]].
[[Douglas Gairdner]] joined him in 1945 as his first assistant and stayed until 1948 during which time Spence served as a mentor to the younger Gairdner. Spence urged Gairdner to write a review of infant [[circumcision]], which was published in the ''British Medical Journal'' on Christmas Eve, 1949.<ref name="fate1949">{{GairdnerDM 1949}}</ref>
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