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Nicholas Steel

2002-03 Harkness Fellow Honorary fellow Cambridge University Specialist registrar Public health medicine

Harkness Project Title: 

The Development of Population Survey Measures of Technical and Patient-Centered Quality of Health Care for Major Disabling Conditions

Mentors: Elizabeth McGlynn, Ph.D., and Paul Shekelle, M.D., Ph.D.

Placement: RAND Corporation

Biography at time of Harkness Fellowship: Nicholas Steel is a 2002–03 Commonwealth Fund Harkness Fellow in Health Care Policy, based at RAND Health in Santa Monica. He is conducting research into the development of technical and patient-centered measures of the quality of health care, for use in national and international population surveys. Immediately prior to his Harkness Fellowship, Steel was an honorary fellow in Cambridge University’s Department of Public Health and Primary Care and a specialist registrar in public health medicine. He was a clinical governance reviewer for the Commission for Health Improvement and a member of the British Medical Association’s Committee for Public Health Medicine and Community Health for England. Previously, he was a practicing family physician and held a National Health Service research fellowship. Steel has experience of different health care systems, having worked as a physician in primary and secondary care in England, Scotland, Australia, and New Zealand. He is also a member of the Faculty of Public Health Medicine of the Royal College of Physicians, where he served as a faculty training accreditation visitor. He was awarded a 1999 Tripos Prize for public health from Trinity College, Cambridge University.


Project: The immediate objective of Steel’s project was to develop a module or set of population survey questions about health care quality for several disabling conditions, to be used in population-based interview surveys (e.g., English Longitudinal Study of Aging, U.S. Health and Retirement Survey).  She developed a set of quality indicators through a formal Delphi group, and validated these through field pilots. 

Career Activity Since Fellowship


  • Clinical Senior Lecturer in Primary Care, University of East Anglia, 2004
  • National Primary Care Researcher Development Award, 2003
  • Clinical Senior Research Associate and Honorary Consultant in Public Health Medicine, University of Cambridge and NHS Norfolk, 2003

Current Position: Clinical Senior Lecturer in Primary Care &Honorary Consultant in Public Health, University of East Anglia. (Updated 1/2014)

E-Mail: [email protected]

Selected Publications

Stokes T, Steel N. “NICE's role in further developing the Quality and Outcomes Framework is in question,” BMJ. 2014.

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,” J Clin Epidemiol. 2014.

Cox J, Steel N, Clark A, Kumaravel B, Bachmann M. "Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management," British Journal of General Practice (BJGP). 2013.

Steel N, Melzer D, Richards S. "Quality of Health Care Approaches and Findings From the English Longitudinal Study of Ageing," Annual Review of Gerontology and Geriatrics. 2013.

Gillam S, Steel N. "The Quality and Outcomes Framework – where next?" British Medical Journal. 2013.

Fleetcroft R, Steel N, Cookson R, Walker S, Howe A. “Incentive payments are not related to expected health gain in the pay for performance scheme for UK primary care: Cross-sectional analysis.” BMC Health Services Research. 2012.

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.

Hammouche, S, Holland, R and Steel, N. "Does quality of care for hypertension in primary care vary with postcode area deprivation? An observational study," BMC Health Services Research. 2011.

Fleetcroft, R, Cookson, R, Steel, N and Howe, A. "Correlation between prescribing quality and pharmaceutical costs in English primary care: national cross-sectional analysis," British Journal of General Practice. 2011.

Scullard, P, Abdelhamid, A, Steel, N and Qureshi, N.  "Does the evidence referenced in NICE guidelines reflect a primary care population?" British Journal of General Practice. 2011.

Fleetcroft R, Parekh-Bhurke S, Howe A, Cookson R, Swift L, Steel N. "The pay-for-performance programme in primary care: estimation of population mortality reduction in England," British Journal of General Practice. 2010;60:e345-52

Steel, N and Willems, S. "Research learning from the UK Quality and Outcomes Framework: a review of existing research," Quality in Primary Care. 2010. 

Ampikaipakan, S, Wilson, AM and Steel, N.  "Complementary therapies for smoking cessation - a useful tool or merely a smoke screen?" European Respiratory Disease. 2009.

Pierce, M, Zaninotto, P, Steel, N and Mindell, J. "Undiagnosed diabetes - data from the English Longitudinal Study of Ageing," Diabetic Medicine. 2009.

Vedavanam, S, Steel, N, Broadbent, J, Maisey, SP and Howe, AC. "Recorded quality of care for depression in general practice - an observational study," British Journal of General Practice. 2009.

Broadbent, J, Maisey, SP, Holland, RC and Steel, N. "Recorded quality of primary care for osteoarthritis: an observational study," British Journal of General Practice. 2008.

Fleetcroft, R, Steel, N, Cookson, RA and Howe, AC. "Mind the gap! Evaluation of the performance gap attributable to exception reporting and target thresholds in the new GMS contract: national database analysis," BMC Health Services Research. 2008.

Furler, J, Cleland, J, Del Mar, C, Hanratty, B, Kadam, U, Lasserson, D, McCowan, C, Magin, P, Mitchell, C, Qureshi, N, Rait, G, Steel, N, van Driel, M and Ward, A. "Leaders, leadership and future primary care clinical research," BMC Family Practice. 2008.

Lang, I, Gibbs, S, Steel, N and Melzer, D. "Neighbourhood deprivation and dental service use: a cross-sectional analysis of older people in England," Journal of Public Health. 2008.

Maisey, SP, Steel, N, Marsh, R, Gillam, S, Fleetcroft, R and Howe, AC.  "Effects of payment for performance in primary care: qualitative interview study," Journal of Health Services Research and Policy. 2008.

Soper, B, Buxton, M, Hanney, S, Oortwijn, W, Scoggins, A, Steel, N and Ling, T. "Developing the protocol for the evaluation of the Health Foundation's 'Engaging with Quality Initiative': an emergent approach," Implementation Science. 2008.

 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,” BMJ. 2008.

Steel N, Clark A, Lang I, Wallace RB, Melzer D. “Racial disparities in receipt of hip and knee joint replacements are not explained by need: Health and Retirement Study 1998 - 2004.” The Journal of Gerontology: Medical Sciences. 2008.

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.

Steel N, Melzer D, Shekelle PG, Wenger NS, Forsyth D, McWilliams BC. “Developing quality indicators for older adults: transfer from the USA to the UK is feasible,” Quality and Safety in Health Care. 2004.

Steel, N and Maisey, S. "The quality of health care received by older people in England," Journal of Epidemiology & Community Health. 2007.

Steel, N, Maisey, SP, Clark, AB, Fleetcroft, R and Howe, AC. "Quality of clinical primary care and targeted incentive payments: an observational study," British Journal of General Practice. 2007.

Steel, N and Lang, I.  "Feeling depressed and being depressed: age and wealth-related disparities in symptoms and diagnosis in ELSA," Gerontologist. 2006.

Steel, N, Melzer, D, Gardener, E and McWilliams, B. "Need for and receipt of hip and knee replacement--a national population survey," Rheumatology (Oxford). 2006.

Fleetcroft, Robert and Steel, Nicholas. "Secondary prevention of heart disease with statins : findings are unexpected," BMJ. 2005.

Steel, N. "Approaches to Evaluating Health Services," Journal of Medical Genetics. 2005.

Steel, N.  "Hip and knee replacements,"Gerontologist. 2005.

Steel, N, Melzer, D, Gardner, L and McWilliams, B.  "Who needs a major joint replacement in England, who gets one, and does diagnosis matter?" Family Practice 2005.

Steel, N, Melzer, D, Shekelle, PG, Wenger, NS, Forsyth, D and McWilliams, BC. "Developing quality indicators for older adults: transfer from the USA to the UK is feasible," Quality and Safety in Health Care. 2004.