Dr John Segarajasinghe Also known as The Pine Street Medical Practice

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved patients in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed patient’s care and worked with other services to achieve this.

At our last assessment, we rated this key question as Good. At this assessment, the rating remains the same.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice made sure patient’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Feedback from patients using the service was positive. Patients felt involved in any assessment of their needs. The 2026 National GP Patient Survey showed 95% of respondents said their needs were met at their last appointment, which was above the local average of 89% and national average of 90%.

Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff checked patient’s health, care, and wellbeing needs during health reviews.

Systems were in place to identify patients with caring responsibilities at registration, opportunistically and through self-reporting. The service maintained a carers’ register, and 3.5% of the practice population were identified as carers.

The practice had effective systems to identify patients with previously undiagnosed conditions. Staff could refer patients with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

As part of the assessment, a number of set clinical record searches were undertaken by a CQC GP specialist advisor. A sample of the records of patients withlong-term health conditionswas checked to ensure the required monitoring was taking place.

We reviewed asthma patients and we identified a total of 17 patients with asthma who have been prescribed2 or more courses of rescue steroids in the last 12 months. The search identified that patients were monitored effectively, with appropriate follow‑up arrangements to support safe and effective long‑term condition management.

We reviewed patient with a potential missed diagnosis of diabetes and we identified 1 patient. Following our review, the practice demonstrated that the patient had subsequently been appropriately coded within the clinical system.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff told us that the leaders provided opportunities for them to keep up to date with current guidelines, and changes to evidence-based care and treatment, for example through training days, clinical meetings and learning from clinical audits. The service monitored and improved outcomes for patients by carrying out clinical audits.

The service operated a recall system, and staff contacted patients when reviews were due, for example, for a long-term condition review and follow-up arrangements were in place for patients who did not respond to invitations.

Our clinical searches showed that patients with long-term conditions, including asthma, hypothyroidism and diabetes, had been appropriately reviewed and monitored, with required investigations and follow-up completed.

Clinical searches demonstrated that patients with long-term conditions, including asthma, hypothyroidism and diabetes and those prescribed medicines requiring monitoring were generally managed in line with evidence-based guidance. Appropriate follow-up had been undertaken for patients who required blood tests, medication monitoring, or clinical reviews, and medication reviews were appropriately documented. Systems were in place to manage medicines safety alerts and recalls, with evidence that appropriate action had been taken.

Areas for improvement identified through clinical searches and prescribing data were recognised, the practice had reviewed the identified areas and implemented measures to support improvement in prescribing and medicines management, with ongoing monitoring planned to ensure that progress was sustained.

The practice worked well across teams and services to support patients. They made sure patients only needed to tell their story once by sharing their assessment of needs when patient moved between different services.

Staff had access to the information they needed to appropriately assess, plan, and deliver patient’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.

Systems were in place to monitor referrals to other services and to support timely access to care. Referrals were tracked to ensure that appointments were arranged within appropriate timescales. For example, checks were routinely undertaken to confirm that patients referred urgently to cancer services had received hospital appointments.

Staff described a positive and collaborative working culture, with a shared commitment to delivering high-quality care and treatment to patients. Staff reported that they felt valued, supported and encouraged by leaders.

The practice supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support.

Staff focussed on identifying risks to patients’ health, including those in the last 12 months of their lives, patients at risk of developing a long-term condition and those with caring responsibilities. Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.

The practice did not always routinely monitor patient’s care and treatment to continuously improve it. They did not always ensure outcomes were positive, consistent or the expectations of patient themselves.

Regular audits were completed to ensure care was provided for patients who required regular monitoring or were prescribed high risk medicines. Audit outcomes were discussed at clinical meetings, and learning was shared with staff.

The practice was below the minimum national target for childhood immunisation uptake between 1 April 2024 to 31 March 2025. The practice met 1 of 5 national targets for the uptake of childhood immunisations. The practice met the minimum uptake of 90% for children aged one year who had completed a primary course of immunisations for Diphtheria, Tetanus, Polio, Pertussis, Haemophilus influenza type b (Hib), Hepatitis B (Hep B) at 91.7%. The practice did not meet the target for the other 4 national targets for childhood immunisations with the minimum uptake of 80% which included 60% for children aged 2 who had received their booster immunisation for Pneumococcal infection, 53.3% for children aged 2 who had received immunisations for measles, mumps and rubella (MMR), 60% for children aged 2 who had received immunisations for the Haemophilus influenza type b (Hib) and Meningitis C (MenC) which is below the 90% minimum uptake and 70.6% for children aged 5 who had received their second dose of MMR.

The practice was below the national target of for cervical screening uptake as of 30 June 2024, with 62% of eligible patients aged 25 to 49 screened within the previous 3.5 years (expected average is 70%) and 73.8% of eligible patients aged 50 to 64 screened within the previous 5.5 years (expected average is 80%).

To improve childhood immunisations and cervical screening uptake, the practice followed up patients by telephone and text and when patients contacted the practice, staff would opportunistically offer appointments to patients and self-booking links were used to make it easier for patients to arrange appointments. The practice offered extended access appointments including evening and weekend appointments, and specific childhood immunisation and cervical screening clinics were available across different sites within the Primary care network.

The number of new cancer cases treated resulting from an urgent suspected cancer referral, between 1 April 2024 to 31 March 2025, was above the expected average with 58.3% observed, compared with an expected 53.9%.

The service was below the NHS England averages for breast and bowel cancer screening, between 1 April 2024 to 31 March 2025, with 63.5% breast screening in 53 to 70 years old (national average is 70.4%), and 65.1% for bowel cancer screening for 60 to 74 years old (national average 71.8%).

The practice told patients about their rights around consent and respected these when delivering person-centred care and treatment. Patient’s feedback demonstrated they felt at ease during consultations, were listened to and procedures were explained well. Patient were appropriately informed when making care and treatment decisions.

Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. Staff were aware of the importance of ensuring a patient had given their consent before sharing information with others. We reviewed staff training and saw that all staff had completed training in consent and mental capacity.

Chaperone posters were clearly displayed on the premises informing patients this was available to them. Patients were offered a chaperone during examinations to support informed consent, and their preferences were respected and recorded where appropriate

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were found to be appropriate and had been made in accordance with relevant legislation.

However, DNACPR decisions were not coded within the patients’ clinical records. The practice used an external system that was integrated with its clinical system, where a patient’s DNACPR status was displayed when their clinical record was opened. This system was also accessible to external healthcare agencies involved in the patient’s care. Following our feedback, the practice took action to address this and had subsequently coded the DNACPR decision within the patient’s clinical record.