Biography

My research interests focus on preventing adverse events and improving outcomes in people with complex health problems managed in primary care. Current research projects include a NIHR funded trial of goal setting with high risk patients in primary care, and digital health in large population studies including the English Longitudinal Study of Ageing, primary care databases (THIN and CPRD), and the Global Burden of Disease Study.
After graduating from Bristol medical school, I combined vocational training for general practice in Sheffield with 2 years in Australia and New Zealand, which included remote hospital obstetrics, tertiary centre respiratory medicine, and trauma experience as a ski patrol doctor. Returning to work as a general practitioner in the contrasting environments of urban deprivation in Wester Hailes, Edinburgh and rural North Norfolk, my early research showed how different the views of patients, GPs and hospital clinicians were about the balance of benefits and harms from treating raised blood pressure. I 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, before returning to the ideal research population of Norfolk.
I supervise postgraduate students and welcome applications from others interested in obtaining a PhD. I teach medical students and doctors in training, and doctors and specialists on the NHS regional public health training programme.

Career History

  • 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 a NIHR funded trial of goal setting with high risk patients in primary care, and digital health in large population studies including the English Longitudinal Study of Ageing, primary care databases (THIN and CPRD), and the Global Burden of Disease Study.

Previous research projects include measuring health care quality in the English Longitudinal Study of Ageing, 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. 

Academic Background

  • 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

Highlighted Publications

See All

Steel, N., Fleetcroft, B., Hassan, Y.

(2017)

Prescribing statins in general practice: who decides?,

in British Journal of General Practice

67.

pp. 246-247

Full Text

(Editorial)

(Published)


Steel, N., Shekelle, P.

(2016)

After 12 years, where next for QOF?,

in BMJ

354.

Full Text

(Editorial)

(Published)


(2016)

Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015,

in The Lancet

388.

pp. 1545-1602

Full Text UEA Repository

(Article)

(Published)


Gitsels, L. A., Kulinskaya, E., Steel, N.

(2016)

Survival benefits of statins for primary prevention: a cohort study,

in PLoS ONE

11.

Full Text UEA Repository

(Article)

(Published)


Steel, N., Hardcastle, A. C., Clark, A., Mounce, L. T. A., Bachmann, M. O., Richards, S. H., Henley, W. E., Campbell, J. L., Melzer, D.

(2014)

Self-reported quality of care for older adults from 2004 to 2011: a cohort study,

in Age and Ageing

43.

pp. 716-20

Full Text UEA Repository

(Article)

(Published)


Steel, N., Abdelhamid, A., Stokes, T., Edwards, H., Fleetcroft, R., Howe, A., Qureshi, N.

(2014)

A review of clinical practice guidelines found that they were often based on evidence of uncertain relevance to primary care patients,

in Journal of Clinical Epidemiology

67.

pp. 1251–1257

Full Text UEA Repository

(Article)

(Published)


Gillam, S. J., Siriwardena, A. N., Steel, N.

(2012)

Pay-for-performance in the United Kingdom: impact of the quality and outcomes framework: a systematic review,

in Annals of family medicine

10.

pp. 461-468

Full Text UEA Repository

(Article)

(Published)


All Publications

See Highlights
<- Page 1 of 5 ->

Gitsels, L. A., Kulinskaya, E., Steel, N.

(2017)

Survival prospects after acute myocardial infarction in the UK: a matched cohort study 1987–2011,

in BMJ Open

7

(1)

article no. e013570

Full Text UEA Repository

(Article)

(Published)


Smith, T. O., McKenna, M. C., Salter, C., Hardeman, W., Richardson, K., Hillsdon, M., Hughes, C. A., Steel, N., Jones, A. P.

(2017)

A systematic review of the physical activity assessment tools used in primary care,

in Family Practice

34

(4)

pp. 384-391

Full Text UEA Repository

(Article)

(Published)


Ford, J. A., Kharicha, K., Clarke, C. S., Clark, A., Iliffe, S., Goodman, C., Manthorpe, J., Steel, N., Walters, K.

(2017)

Service use of older people who participate in primary care health promotion: a latent class analysis,

in BMC Health Services Research

17

article no. 176

Full Text UEA Repository

(Article)

(Published)


Steel, N., Fleetcroft, B., Hassan, Y.

(2017)

Prescribing statins in general practice: who decides?,

in British Journal of General Practice

67

(659)

pp. 246-247

Full Text

(Editorial)

(Published)


Brainard, J. S., Ford, J. A., Steel, N., Jones, A. P.

(2016)

A systematic review of health service interventions to reduce use of unplanned health care in rural areas,

in Journal of Evaluation in Clinical Practice

22

(2)

pp. 145-155

Full Text UEA Repository

(Article)

(Published)


Fleetcroft, R., Noble, M., Martin, A., Coombes, E., Ford, J., Steel, N.

(2016)

Emergency hospital admissions for asthma and access to primary care: cross-sectional analysis,

in British Journal of General Practice

66

(650)

pp. e640-e646

Full Text UEA Repository

(Article)

(Published)


Verma, P., Ford, J., Stuart, A., Howe, A., Everington, S., Steel, N.

(2016)

A systematic review of strategies to recruit and retain primary care doctors,

in BMC Health Services Research

16

article no. 126

Full Text UEA Repository

(Article)

(Published)


Ford, J., Wong, G., Jones, A., Steel, N.

(2016)

Access to primary care for socio-economically disadvantaged older people in rural areas: A realist review,

in BMJ Open

6

(5)

article no. e010652

Full Text UEA Repository

(Article)

(Published)


Hassan, Y., Ford, J., Steel, N., Sheldon, J., Fleetcroft, R.

(2016)

Why are statin prescribing guidelines for primary prevention not always followed in primary care?,

in British Journal of General Practice

66

(651)

pp. 536-537

Full Text

(Comment/debate)

(Published)


(2016)

Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015,

in Lancet HIV

3

(8)

pp. e361-e387

Full Text UEA Repository

(Article)

(Published)


Steel, N., Shekelle, P.

(2016)

After 12 years, where next for QOF?,

in BMJ

354

article no. i4103

Full Text

(Editorial)

(Published)


(2016)

Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015,

in The Lancet

388

(10053)

pp. 1813-1850

Full Text UEA Repository

(Article)

(Published)


(2016)

Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015,

in The Lancet

388

(10053)

pp. 1603-1658

Full Text UEA Repository

(Article)

(Published)


(2016)

Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015,

in The Lancet

388

(10053)

pp. 1545-1602

Full Text UEA Repository

(Article)

(Published)


(2016)

Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015,

in The Lancet

388

(10053)

pp. 1725-1774

Full Text UEA Repository

(Article)

(Published)


(2016)

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015,

in The Lancet

388

(10053)

pp. 1659-1724

Full Text UEA Repository

(Article)

(Published)


Gitsels, L. A., Kulinskaya, E., Steel, N.

(2016)

Survival benefits of statins for primary prevention: a cohort study,

in PLoS ONE

11

(11)

article no. e0166847

Full Text UEA Repository

(Article)

(Published)


Fleetcroft, R., Hardcastle, A., Purdy, S., Lipp, A., Price, G., Steel, N., Myint, P., Howe, A.

(2016)

Which types of emergency medical admissions may be preventable? Analyses of 132 randomly selected cases,

(Abstract)

(Published)


Mounce, L. T. A., Steel, N., Hardcastle, A., Henley, W. E., Bachmann, M., Campbell, J., Clark, A., Melzer, D., Richards, S.

(2015)

Patient characteristics predicting failure to receive indicated care for type 2 diabetes,

in Diabetes Research and Clinical Practice

107

(2)

pp. 247–258

Full Text UEA Repository

(Article)

(Published)


Hardcastle, A., Mounce, L. T. A., Richards, S., Bachmann, M., Clark, A., Henley, W. E., Campbell, J., Melzer, D., Steel, N.

(2015)

The dynamics of quality: a national panel study of evidence-based standards,

in Health Services and Delivery Research

3

(11)

Full Text UEA Repository

(Article)

(Published)


<- Page 1 of 5 ->

Key Research Interests

My research is aimed at improving the quality, safety and equity of health care, particularly for older people with long term conditions. I lead the development and analysis of questions about quality of health care for people aged 50 and over in the English Longitudinal Study of Ageing, in collaboration with colleagues from University College London, RAND Health Santa Monica, Institute for Fiscal Studies, and Exeter University. Recent analysis has been funded by the National Institute of Health Research HS&DR programme. See:

  • 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

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 and Steel, N (2013) The Quality and Outcomes Framework--where next? British Medical Journal, 346. f659-f659.
  • 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

The rise in guidelines and performance indicators is not without risks from over treatment, and in collaboration with NICE and Nottingham University, we have recently completed a study to investigate 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)

Comparative effectiveness studies include observational effectiveness studies conducted in routine healthcare settings in collaboration with National Health Service colleagues, with recent examples being referral management and case management in primary care, and tier 3 obesity. See:

  • Cox J, Steel N, Clark A, Kumaravel and Bachmann M (2013) Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management. British Journal of General Practice (BJGP), 63 (611). e386-e392. ISSN 09601643

Plans for future research involve observational studies of the effectiveness of health system changes as routine primary care data become available at population level, and the development of better patient-centred outcomes for research into complex interventions in primary care.

Key Research Words:

Quality of health care

Pay for performance

Primary care

Cohort studies

Older people

Routine data

Health policy

Health service evaluations

Clinical guidelines

Health services research

Postgraduate Research Student Supervision:-

Quality of health care

Primary care

Comparative effectiveness studies

Integrated care

Health care systems

Older people

Clinical guidelines

Long term conditions

Patient centred outcomes

Cohort data analysis

Selected Publications

  1. 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
  2. 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/afu091Gillam S, Steel N. The Quality and Outcomes Framework – where next? British Medical Journal 12 April 2013;346:f659
  3. Gillam S, Siriwardena N, Steel N. Pay-for-performance in the UK: the impact of the Quality and Outcomes framework - systematic review. Annals of Family Medicine September/October 2012;10:5:461-468, doi: 10.1370/afm.1377
  4. 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
  5. Steel N, Maisey S, Clark A, Fleetcroft R, Howe A. Quality of clinical primary care and targeted incentive payments: an observational study. British Journal of General Practice 2007;57:449-454

Current Research Projects and Grants

  • Improving access to high quality primary care for socio-economically disadvantaged older people in rural areas (supervisor for John Ford Doctoral Research Fellowship), NIHR - National Institute for Health Research, £396,742, Oct 2014– Sept 2018

  • Anticholinergics, Benzodiazepines, Cognition and Dementia (co-applicant), Alzheimer’s Disease Society, £318,228, 01/08/14-31/07/17

  • English Longitudinal Study of Ageing UK Funders application (co-applicant), Consortium of UK Government departments, £2,670,000, Apr 2014-Mar 2018

  • Can a practice based approach using Significant Event Audit reduce non-elective hospital admissions? (co-applicant), NIHR - National Institute for Health Research, RfPB, £198,80, Jan 2014-Aug 2015

  • The dynamics of quality: a national panel study of evidence-based standards (PI), National Institute for Health Research, Health Services Research, £225,299, June 2012-Dec 2013
  • Are NICE clinical guidelines for primary care based on evidence from primary care? (PI), National Institute for Health Research, RfPB, £226,453, July 2011 – July 2013
  • The English Longitudinal Study of Ageing NIA Application for Renewal (ELSA) (co-applicant), USA National Institute on Aging, US $7,031,992 (£4,523,359), 2010-14
  • ELSA UK funders Application for Renewal (co-applicant), Office for National Statistics on behalf of a government consortium, £4,350,000, 2010-14

Teaching Interests

Responsibilities for teaching include leading the year 3 research methods teaching for medical (MBBS) students at UEA to write a research protocol, and supervising doctors and specialists on NHS regional training programmes in public health and general practice, including Foundation doctors and Academic Clinical Fellows. Postgraduate teaching includes supervising and examining PhD and Masters students.

External Activities and Indicators of Esteem

  • Academic Training Programme Director for East of England School of Public Health
  • ‘Implementation Science’ Editorial Board (2012-) (http://www.implementationscience.com/about/edboard)
  • Norfolk & Suffolk Primary & Community Care Research Steering Group (2013-)
    Oxford International Primary Care Research Leadership Programme (2007-18) (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-)

Professional Activities

  • Honorary Public Health Academic Consultant, Public Health England
  • Academic Training Programme Director, East of England School of Public Health

Administrative Posts

  • Deputy Associate Dean for Research, Faculty of Medicine and Health Sciences

  • Research Methods and Clinical Audit Steering Group