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, and the Global Burden of Disease Study.

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.

Burden of disease and life expectancy

Polulation ageing

Epidemiology and 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.

Supervising medical students on the UEA MBBS course.

• 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 and the Global Burden of Disease Study.

Previous research projects include goal setting with high risk patients in primary care, analysing primary care databases (THIN and CPRD), 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. 

My research is aimed at improving population health, particularly for older people with long term conditions.

I collaborate with colleagues in the UK Office for Health Improvement and Disparities, and interpret the findings of the Global Burden of Disease study locally, nationally and internationally. See:

• Steel N, Bauer-Staeb C, Ford J, GBD 2021 Europe Life Expectancy Collaborators, Newton J. Changing life expectancy in European countries 1990-2021: a subanalysis of causes and risk factors from the Global Burden of Disease Study. Lancet Public Health 2025, Volume 10, Issue 3, e172 - e188
• 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
• Extensively referenced in the HNS Long Term Plan 2019: NHS Long Term Plan » The NHS Long Term Plan

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. See:

• Beach B, Steel N, Steptoe A, Zaninotto P. Associations of cognitive impairment with self-isolation and access to health and care during the COVID-19 pandemic in England. Scientific Reports 2023, 13(1), 5026. Doi: 10.1038/s41598-023-31241-3
• 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

Our NIHR trial of goal setting with high risk multimorbid patients in primary care led to 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
• Murdoch J, Salter C, Ford J, Leneghan E, Shiner A, Steel N. The "unknown territory" of goal-setting: Negotiating a novel interactional activity within primary care doctor-patient consultations for patients with multiple chronic conditions. Social Science & Medicine doi: 10.1016/j.socscimed.2020.113040
• 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
• Akter N, Kulinskaya E, Steel N, Bakbergenulya I. The effect of hormone replacement therapy on the survival of UK women: a retrospective cohort study 1984−2017. British Journal of Obstetrics & Gynaecology 2021. Doi: 10.1111/1471-0528.17008

The rise in guidelines and performance indicators is not without risks from over treatment, and 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 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, £4,229,000, 2024 - 2028

• PREDICTion of GastroIntestinal malignancy in patients with IRON Deficiency (PREDICT-GI-IRON), £150,000, 2024 - 2026