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Lesson planC160 minsNew. New: checked automatically for level, grammar, facts and originality; a teacher's review is still to come. Spotted a mistake? Tell us.
It Is Essential That…: The subjunctive
Students learn the subjunctive after verbs and phrases like insist and it is essential that, then write a formal notice announcing new rules.
Subjunctive · Health · Rules
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Plan at a glance
Aims
- Use subjunctive accurately
- Learn and use 15 words and phrases in 2 sets: Rules and requirements, Words that take the subjunctive
- Read for detail: New rules at Ferncliffe
- Writing task: a notice about new rules
Stages · 60 min
- 5 minLead-in: Pairs talk about health and share ideas with the class.
- 5 minVocabulary: Ex. 1
- 5 minLanguage focus: Go through the grammar notes together and check understanding.
- 5 minControlled practice: Ex. 2
- 5 minAccuracy practice: Ex. 3
- 5 minVocabulary: Ex. 4
- 5 minAccuracy practice: Ex. 5
- 10 minReading: Ex. 6
- 15 minWriting: Ex. 7
Printables
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Download all (ZIP, 2 PDFs)Grammar notes
The subjunctive after verbs and adjectives
- After verbs such as insist, recommend, suggest, demand, propose and request, formal English uses the base form of the verb for every person: The doctor insisted that he rest. (not rests)
- The same happens after adjectives such as essential, vital, imperative and crucial: It is essential that every patient sign the form.
- Make it negative with not + base form: We recommend that she not drive for 24 hours.
- Be stays be, which makes passives easy to spot: It is vital that the room be cleaned every day.
- In British English, should + base form is also very common and correct: It is essential that she should rest.
were to for unlikely situations
- If + were to + base form makes a future situation sound unlikely or formal: If the clinic were to close, patients would have to travel forty miles.
- Formal English uses were for every person in hypothetical situations: If I were you, I would ask for a second opinion.
Study tips
- Look for the trigger: a verb like insist or recommend, or an adjective like essential, followed by that.
- Read official notices and leaflets: rules and guidelines are full of subjunctives.
Glossary
- Rules and requirements7 items
- Words that take the subjunctive8 items
Complete the exercises, then check your answers.
1
Rules and procedures
Match each word with its meaning. There is one extra meaning.
Tap an item…
…then its match
2
Doctor's orders
Complete the sentences with the correct form of the verb in brackets.
- a
The consultant insisted that Mr Hale (stay) in hospital for another night.
- b
It is imperative that every patient (give) written consent before the procedure.
- c
The clinic's guidelines stipulate that all equipment (be) cleaned after each use.
- d
We strongly recommend that you (not / drive) for 24 hours after the anaesthetic.
- e
If the clinic (be) to close, patients would have to travel forty miles to the nearest hospital.
- f
The inspectors' report demanded that waiting times (reduce) to under two weeks.
- g
Is it essential that I (bring) my previous test results with me?
- h
Dr Osei suggested that the nurse (check) the patient's blood pressure every hour.
3
Key word transformations
Complete the second sentence so that it means the same as the first. Use the word in capitals and between three and six words, including the word given.
- a
'You really must rest for a week,' the doctor told Anna.
INSISTED
The doctor for a week.
Use 2–6 words, including the word given.
- b
Every visitor has to wash their hands before entering the ward.
ESSENTIAL
It is their hands before entering the ward.
Use 2–6 words, including the word given.
- c
It's very unlikely, but if the hospital closed, the town would lose 300 jobs.
WERE
If the hospital , the town would lose 300 jobs.
Use 2–6 words, including the word given.
- d
'Why don't you get a second opinion?' my sister said to me.
SUGGESTED
My sister a second opinion.
Use 2–6 words, including the word given.
- e
The rules say that patients must not use mobile phones on the ward.
STIPULATE
The rules mobile phones on the ward.
Use 2–6 words, including the word given.
- f
The committee's idea was a new rule: all staff must take a first-aid course.
PROPOSED
The committee a first-aid course.
Use 2–6 words, including the word given.
4
Word formation
Use the word in capitals to form a word that fits the gap.
- a
Wearing a mask is in all treatment rooms: nobody may enter without one.
COMPEL - b
The new rules apply to everyone, and there are no , not even for senior staff.
EXEMPT - c
Inspectors praised the staff's strict to the hygiene guidelines.
ADHERE - d
The operation is a routine and most patients go home the same day.
PROCEED - e
Patients sat in the waiting room, hoping to hear their names.
ANXIETY - f
The doctor's was clear: two weeks of complete rest.
RECOMMEND
5
Find and correct the mistake
Each sentence has one mistake. Write the correction.
- a
The doctor suggested me to stay at home for a few days.
- b
If the clinic were close, patients would have to travel forty miles.
- c
Patients are required that they bring photo ID to every appointment.
- d
It is essential that you not to eat anything after midnight.
- e
If I would be you, I'd ask for a second opinion.
- f
The board demanded the manager to explain the long waiting times.
6
Read: New rules at Ferncliffe
Read the newsletter article. Are the sentences true, false or not given?
From 1 March, Ferncliffe Health Centre will introduce a set of guidelines that, in the words of its director, Dr Miriam Achebe, "put safety before convenience". The changes follow an inspection last autumn, which recommended that the centre review the way it records patient consent. Under the new procedure, it is compulsory that every patient sign a consent form before any treatment, however minor. Until now, verbal agreement has been accepted for routine checks such as blood tests. Dr Achebe insists that the form be kept short. "If it were to run to five pages," she says, "nobody would read it." The guidelines also stipulate that visitors not enter the treatment rooms unless a nurse invites them in. Parents of children under sixteen are exempt from this rule. Staff, meanwhile, must adhere to a stricter cleaning routine: it is imperative, the guidelines say, that every surface be wiped down between appointments. Not everyone is pleased. Some patients have complained that the extra paperwork will lengthen waiting times, and a local residents' group has demanded that the centre extend its opening hours to make up for it. Dr Achebe says she is open to the idea but has not made a decision. "We will see how the first three months go," she said.
- a
The new guidelines were introduced after an inspection.
- b
Until now, patients have always had to sign a form before a blood test.
- c
Dr Achebe wants the consent form to be brief.
- d
Parents of young children may go into treatment rooms without being invited.
- e
The centre has employed extra cleaners to wipe surfaces between appointments.
- f
All patients are happy with the changes.
- g
The residents' group wants the centre to open for longer.
- h
Dr Achebe used to work as a hospital surgeon.
7
Write: a notice about new rules
Write a formal notice or email.
You manage a gym, library, school or clinic that is introducing new rules. Write a formal notice or email (180–220 words) to its users. Explain what will change and why, what people must or must not do, and what would happen if the rules were to be ignored. Use the subjunctive at least five times (It is essential that…, We insist that…, We recommend that…, If … were to…). Word box: guideline · compulsory · consent · procedure · stipulate · adhere to · imperative · exempt Example: From next month, it is compulsory that all members sign in at reception. We recommend that you arrive ten minutes early, and we insist that the new guidelines be followed by everyone.
Suggested minimum: 180 words
0 words · aim for at least 180
Spotted a mistake in this lesson?· tell us the exercise and item
Revise with a game
This lesson's own words and questions. Play on your own, or in teams on the classroom screen.
- Step UpAnswer the lesson's questions to climb to the top.
- Pair UpMatch the lesson's words to their meanings against the clock.
- SnapA word and a meaning: do they go together? Answer fast.
- Fix ItFind the mistake in each sentence, then correct it.
- Quiz BoardTeams choose questions worth 100 to 500 points.
- Retro arcadeWord Invaders, Word Snake, Word Maze and Word Crossing: classic arcade games with the lesson's words.
Glossary
The 15 words and phrases this lesson teaches, in 2 sets.
Rules and requirements
- guideline
- a piece of official advice about how something should be done
- compulsory
- required by a rule, so you must do it
- procedure
- a fixed set of steps for doing something, or a medical operation
- stipulate
- to state clearly in a rule or agreement that something must be done
- adhere to
- to follow a rule or plan exactly
- exempt
- not required to do something that other people must do
- consent
- permission that someone gives for something to happen
Words that take the subjunctive
- insist
- to say firmly that something must happen: insist that he leave
- recommend
- to advise that something should be done: recommend that she rest
- require
- to make something necessary by a rule: require that every patient sign
- suggest
- to put forward an idea: suggest that we wait
- demand
- to ask for something very firmly: demand that it be changed
- propose
- to formally suggest a plan: propose that the clinic open earlier
- essential
- completely necessary: it is essential that
- imperative
- extremely important and urgent: it is imperative that
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