Head of Health Services and Primary Care Research Group

Nick’s research interests focus on preventing adverse events and improving health outcomes in older people. Current research projects include measuring health in older participants in the English Longitudinal Study of Ageing including during the COVID-19 pandemic, a study of GPs and people with multiple conditions setting goals together, and applying the Global Burden of Disease Study in England.

After graduating from Bristol medical school, he trained in general practice in Yorkshire, Australia and New Zealand. Working as a general practitioner in the contrasting environments of urban deprivation in Wester Hailes, Edinburgh and rural North Norfolk, he became interested in the different views of patients, GPs and hospital clinicians about the balance of benefits and harms from treating raised blood pressure. He went on to train in public health and health policy at the University of Cambridge and RAND Health in California as a Harkness Fellow in Health Care Policy.

He supervises postgraduate students and doctors and specialists on the NHS regional public health training programme, and teaches medical students and doctors in training.

• Honorary Public Health Academic Consultant, Public Health England

Quality of health care

Epidemiology

Public Health

Supervising doctors and specialists training in public health, including Academic Foundation Programme doctors and Academic Clinical Fellows, and registrars on the NHS regional training programme in public health.

Supervising and examining postgraduate PhD and Masters students.

Teaching medical students on the UEA MBBS course, including research methods.

• PhD: ‘National Population Evaluation of Quality of Health Care: Developing and Using Quality of Health Care Indicators’, University of East Anglia, 2008
• Fellow of the Faculty of Public Health, 2006
• Member of the Faculty of Public Health Medicine, 2001
• Diploma in Public Health (distinction), University of Cambridge, 1999
• Tripos Prize for Public Health, Trinity College, University of Cambridge, 1999
• MSc in Health Sciences, University of East Anglia, 1998
• Member of the Royal College of General Practitioners, 1993
• MB ChB , University of Bristol, 1988

• Professor of Public Health, Norwich Medical School, 2016 - present
• Clinical Reader in Primary Care, 2014 - 2015
• Clinical Senior Lecturer in Primary Care, Norwich Medical School, and Honorary Public Health Academic Consultant at Public Health England, 2004 - 2014
• Honorary Consultant in Public Health Medicine, NHS Norfolk, 2003 - 2013
• Clinical Senior Research Associate, Dept of Public Health & Primary Care, University of Cambridge, 2003 - 2004
• Harkness Fellow in Health Care Policy, RAND Health, Santa Monica, USA, 2002 - 2003
• Specialist Registrar in Public Health Medicine, Norfolk and Cambridgeshire Health Authorities, and University of Cambridge, 1998-2003
• General Practitioner in Norwich and Holt, Norfolk, and Health Services Research Fellow at the University of East Anglia, 1995 - 1998
• General Practice Vocational Training, UK, Australia and New Zealand, 1990 - 1994
• House Officer, Bristol and Weston-Super-Mare, 1988 – 1989

Research interests

Current research projects include the English Longitudinal Study of Ageing, goal setting with high risk patients in primary care, the Global Burden of Disease Study, and primary care databases (THIN and CPRD).

Previous research projects include evaluating primary care for vulnerable adults and refugees, assessing the applicability of NICE guidelines to primary care, managing referrals in general practice, and evaluating local and national effects of UK quality improvement initiatives, including the UK Quality and Outcomes Framework for general practices. 

• Chair, Norfolk Health Authority Specialist Advisory Group for the Health Protection Board (2020 - 2021)
• Chair, UEA Health and Social Care Partners Mass COVID-19 Testing Oversight Board (2020 - 2021)
• ‘Implementation Science’ Editorial Board (2012-2020) (http://www.implementationscience.com/about/edboard)
• Norfolk & Suffolk Primary & Community Care Research Steering Group (2013-2020)
• Oxford International Primary Care Research Leadership Programme (2007-20) (http://www.oxfordleadershipprogramme.co.uk)
• NICE Standing Committee B for Guideline Updates (2014-2016)
• NIHR Health Services & Delivery Research (HS&DR) Programme Healthcare Delivery Research (HDR) Panel (2012-2015)
• NIHR Regional Advisory Committee for the Research for Patient Benefit Programme (RfPB) East of England region (2011-2015)
• Faculty of Public Health Part A Examiner (2010-2015)
• Advisory Committee on Clinical Excellence Awards (ACCEA) East of England (2013-2016)
• Local NHS evaluations (2008-)

My research is aimed at improving the quality, safety and equity of health care, particularly for older people with long term conditions.

I collaborate with colleagues in Public Heath England and the Institute of Health Metrics and Evaluation in Seattle to analyse and interpret the findings of the Global Burden of Disease study at local level in the UK. See:

• Steel N, Ford JA, Newton JN, Davis A, Vos T, Naghavi M, et al. Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018 doi: 10.1016/S0140-6736(18)32207-4

I am an investigator on the English Longitudinal Study of Ageing, in collaboration with colleagues from University College London, the University of Manchester, the Institute for Fiscal Studies, and the National Centre for Social Research. Analysis has been funded by the National Institute of Health Research HS&DR programme. See:

• Zaninotto P, Di Gessa G, Steel N. The experience of older people with multimorbidity during the COVID-19 pandemic. ELSA COVID-19 Substudy rapid report, 2020. (https://www.elsa-project.ac.uk/covid-19)
• Steptoe A, Steel N. The experience of older people instructed to shield or self-isolate during the COVID-19 pandemic. ELSA COVID-19 Substudy rapid report, 2020. (https://www.elsa-project.ac.uk/covid-19)
• Steel N, Hardcastle AC, Clark A, Mounce LTA, Bachmann MO, Richards SH, Henley WW, Campbell JL, Melzer D. Self-reported quality of care for older adults from 2004 to 2011: a cohort study. Age and Ageing 2014;43:716–720; doi: 10.1093/ageing/afu091
• Steel N, Bachmann M, Maisey S, Shekelle P, Breeze E, Marmot M, Melzer D. Self-reported receipt of care consistent with 32 quality indicators: a national population survey of adults over 50 years old in England. British Medical Journal 2008;337;a957

We have recently completed a NIHR funded trial of goal setting with high risk multimorbid patients in primary care, and have implemented the findings into an online open course for GPs interested in learning more about goal setting. See:

• Ford J, Lenaghan E, Salter C, Turner D, Shiner A, Clark A, Murdoch J, Green C, Lipp A, Moseley A, Wade T, Winterburn S, Steel N. Can goal-setting for patients with multimorbidity improve outcomes in primary care? Cluster randomised feasibility trial. BMJ Open 3 June 2019;9:e025332. doi: 10.1136/bmjopen-2018-025332
• Salter C, Shiner A, Lenaghan E, Murdoch J, Ford J, Winterburn S, Steel N. Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations. Br J Gen Pract 3 June 2019; bjgp19X704129. doi: 10.3399/bjgp19X704129
• GP Training: Goal-setting for patients living with multimorbidity. https://www.futurelearn.com/courses/gp-goal-setting-training

I collaborate with colleagues to analyse large UK primary care datasets to inform prescribing decisions in general practice. See:

• Richardson K, Fox C, Maidment I, Steel N, Loke Y, Arthur A, Myint P, Grossi C, Mattishent K, Bennett K, Campbell N, Boustani M, Robinson L, Brayne C, Matthews F, Savva G. Anticholinergic drugs and risk of dementia: case-control study. British Medical Journal 2018;361; doi: 10.1136/bmj.k1315
• Gitsels L, Kulinskaya E, Steel N. Survival benefits of statins for primary prevention: a cohort study. PLOS ONE 2016;11(11): e0166847; doi: 10.1371/journal.pone.0166847

The rise in guidelines and performance indicators is not without risks from over treatment, and in collaboration with NICE and Nottingham University, we investigated the relevance of evidence in NICE guidelines to low risk patients in primary care. See:

• Steel N, Abdelhamid A, Stokes T, Edwards H, Fleetcroft R, Howe A, Qureshi N. A review of clinical practice guidelines found that they were often based on evidence of uncertain relevance to primary care patients. Journal of Clinical Epidemiology 2014 doi: 10.1016/j.jclinepi.2014.05.020 (http://authors.elsevier.com/sd/article/S0895435614003291)

Interest in the effects of pay for performance in primary care has led to primary and secondary research with colleagues from UEA, Cambridge and Lincoln. See:

• Gillam S, Siriwardena N and Steel N (2012) Pay-for-performance in the United Kingdom : impact of the quality and outcomes framework: a systematic review. Annals of Family Medicine, 10 (5). pp. 461-468. ISSN 1544-1717

Key Research Words:

Postgraduate Research Student Supervision:-

Selected Publications

Current Research Projects and Grants

• English Longitudinal Study of Ageing UK Funders application (co-app 10%), Department of Health and Social Care, £2,065,556, 1 Apr 2018-31 Mar 2024

• English Longitudinal Study of Ageing COVID-19 Substudy, Economic and Social Research Council, £498,303, 1 June 2020- 30 Nov 2021

• Forward work on the England Burden of Disease programme (Principal Investigator), Public Health England, £34,757, June 2017-March 2021

• Use of big health and actuarial data for understanding longevity and morbidity risks (co-applicant) Institute and Faculty of Actuaries £873,251, Oct 2016 –
  30 Sept 2021