Garswood SurgeryBillinge RoadGarswoodWigan, Lancashire, WN4 0XDTel: 01744 621670
Your Community Midwife is Leisl Lowe, who can be contacted through the Community Midwives’ office on 0151 430 1234.
If you are planning to have your baby at Whiston Hospital, please contact the Whiston Maternity Department on 0151 430 1234 to arrange your first Midwife appointment.
If you are planning to have your baby at any other hospital, please ask the receptionist to arrange your first appointment with the *Community Midwife here in the surgery (if you haven’t already done so)
*please note that the community Midwife clinic is held at the surgery every Tuesday morning.
The following antenatal care is a guideline only provided by Whiston Hospital. Bookings for other hospitals may vary slightly regarding hospital attendance dates and screenings, but the care provided at the surgery ante-natal clinics is identical for all patients.
When you first find out you’re pregnantCommunity/Hospital Midwife: blood pressure urine dipstick test, take blood, may check the size of the fundus, agree estimated date of confinement, offer dietary and lifestyle advice and obtain any previous antenatal history.
11 – 13 weeks All pregnant women are offered an ultrasound scan to determine gestational age.
12 weeks Hospital booking appointment – at this appointment relevant lifestyle and medical history taken. Information about routine screening tests given, eg:
16 weeks Community Midwife: Discuss and document results of screening tests, obtain Triple test if requested.
20 weeksGP Practice: the Whooping Cough (pertussis) vaccine is offered from 20 weeks into pregnancy. If you would like the vaccine, please contact the surgery to arrange an appointment with the Practice Nurse.
18 – 20 weeks Hospital: Ultrasound scan to check the development of the baby.
25 weeks Community Midwife: Measure blood pressure, test urine (if first pregnancy) Measure the size of the baby and listening to the baby’s heartbeat.
28 weeks Community Midwife: Repeat screening tests for:
31 weeks Community Midwife: Discuss and document results of routine screening tests.
34 weeks Community Midwife: Offer rhesus negative women 2nd dose of anti D and antenatal check.
36 weeks Community Midwife: Routine antenatal checks and check position of baby.
38 weeks Community Midwife: Routine antenatal checks.
40 weeks Community Midwife: Routine antenatal checks.
41 weeks For all women who have not delivered offer membrane sweep.
Classes are held at the maternity hospital or local health centres attached to some GP clinics. You should contact your hospital or clinic to find out their schedule. A good time to start, will be around 30 weeks of your pregnancy. Please note that some classes are women only.
Parent CraftYour midwife will advise you about where parent craft classes are being held and will remind you about attending these classes during your pregnancy.
AerobicsSome hospital offer exercise classes for pregnant women. Information will be given at your booking appointment.
Aqua-natalExercises for pregnant women at local swimming pools. Information will be given at your booking appointment.
When you and your baby come home from hospital, postnatal care will be provided by your Community Midwife who may visit you for up to 28 days following confinement to provide postnatal care.
Frequency of midwife and health visitor visits is determined by the mother’s needs.
Health visitors are registered nurses who usually have at least two years experience in nursing before undergoing their health visitor training. They are usually based in either a GP surgery, or at a health centre, working alongside GPs and other health and social care professionals.
All families with children under five are allocated a health visiting team comprising of Health Visitors, Nursery Nurses, Community Nurse and a Health Care Assistant. Sometimes, first contact with families is at the antenatal stage (before a baby is born). Once a baby is born, and then at various stages within a child's life, depending on need. Health visitors can visit you at home, or see you at the child health clinic.
The service can provide advice and support on a range of problems such as immunisations, sleeping, diet and food, (for both you and your child) accident prevention, difficulty in breast feeding, toddler tantrums, potty training and many more. We can also give information on local services, such as baby massage groups, stop smoking groups and facilities available to you, in your local community.
Remember your health visitor is not just concerned about the health of your child, but of your whole family.
The health visitors assigned to Garswood Surgery is Anne Radice.
There have been recent changes to the number of child health checks that your child will receive. However, your health visitors will be able to provide information and support about child development when needed.
There are different developmental stages within your child's life.
11-28 days after birth Your health visitor will usually visit you at home, between 11-14 days after the birth of your baby. This initial visit can often take up to 2 hours. She will ask you for your Child Health Record Book (Whiston delivery mums). This is your personal record of your child's development until they are well into school age, and will need to be brought to clinic every time you attend. She will discuss this book with you during the visit. If needed, a follow up visit can be arranged and you will be provided with information about the Garswood Surgery baby clinic where you will be able to get your infant weighed and immunised. You will also be given relevant contact numbers. All of this information will be recorded in your Child Health Record Book.
4-8 weeks It is usual to attend the Baby Clinic to get your baby weighed. You can discuss any concerns at this point with the Specialist Nurse Practitioner and, if necessary, your GP. During this visit, the Specialist Nurse Practitioner will also carry out an initial examination of your baby, which often includes weighing, if appropriate. She will also discuss issues such as breastfeeding, sleep routine, safety and childhood immunisations. This visit is an ideal time for you to discuss any concerns that you may have.
At 6 - 9 weeks, we may ask you to fill in a small questionnaire, which can help in detecting post-natal depression. You will also be due a six week check by your GP. Generally, at 6 weeks your baby may now be smiling, be startled by loud noises and recognise familiar voices.
8 weeks Your baby will now be ready for their first set of immunisations. You will usually receive a reminder through the post informing you each time your child is due an immunisation.
12 weeks When you attend Baby Clinic, you may be offered advice about weaning your baby. It is recommended that babies do not start taking solids (food) until they are six months old. During this visit you can discuss types of foods that are suitable to start weaning with, and also foods that should be avoided in the early stages. You will also discuss other issues such as sleep routine, use of safety equipment in the home and general development and health of your child.
You may also be asked to fill in the post natal depression questionnaire which you initially completed at six weeks.
Your child will now be ready for their second set of immunisations.
At this stage, your baby may now be more alert visually and starting to respond to familiar situations and routines, such as bath times and feeds. He or she may also be able to briefly hold a rattle if placed in their hand and may be able to clasp both hands together.
7 - 9 months Your baby will receive a hearing test which will be carried out by the health visitor, or a health visitor and a nursery nurse. An appointment for this will be sent out to you. When you attend for this test, you may be asked to once again to fill in the post-natal depression questionnaire.
At nine months, your baby may now be sitting unsupported and be able to stand with support. He or she may have started to reach out and grasp certain objects and may also have the ability to chew solid food and enjoy finger foods. They may babble tunefully as a form of communication and understand 'no' and 'bye bye'.
2 year check Health visitors usually send out a birthday card when child reach their second birthdays, inviting you to make contact if you have any concerns about the following issues -
They may also feel it is appropriate to carry out a home visit to discuss any concerns with you.
Generally, at two years your child may now be able carry out activities such as kicking a ball, building a tower with 8 bricks, holding a pencil and using a spoon to eat their food.
He or she should be saying single words or more, be able to point to known objects when you ask and also be able to carry out basic instructions. If you have any concerns regarding your child's speech, please contact your health visitor initially.
Often between 18 months and 2½ years, your toddler may ask for the potty/toilet.
4 year check Your child will now be due their pre-school booster immunisations. They may also have their height and weight recorded. If you want to discuss any concerns about your child's health before they start school, you should contact your health visitor initially.
Generally, at this stage your child may now be able to build a tower with 10 bricks, recognise four colours, be able to play with other children in a group, yet also have the ability to concentrate when playing by themselves. They may now also have the ability to get dressed/undressed by themselves.
Any vaccinations your child has received should be entered into your child’s vaccines record book (Red book).
If you think your child may have missed any vaccinations you can check with the surgery or ring the Child Health Department for your area:
Childhood Immunisations are carried out by the Practice Nurse. She has 2 child immunisation clinics per week: Mondays 12pm-1pm and Thursdays 5pm-6pm.
At 8 weeks, your baby will be given vaccines against:
At 12 weeks, your baby will be given vaccines against:
At 16 weeks, your baby will be given vaccines against:
At around 12/13 months your baby will be given vaccines against:
At 3 years 4 months of age (or soon after) your child will receive the pre-school boosters which are:
*Rotavirus (introduced in July 2013) This is an oral vaccine against Rotavirus infection, a common cause of diarrhoea and sickness. It is given as two doses for babies aged 2 months and 3 months alongside their other routine childhood vaccinations. This vaccine is given as a liquid from a dropper straight into the baby’s mouth for them to swallow.
Cash payments only please.
Isn't the NHS supposed to be free? The National Health Service provides most health care to most people free of charge, but there are exceptions: prescription charges have existed since 1951, and there are a number of other services for which fees are charged. Sometimes the charge is made to cover some of the cost of treatment, for example, dental fees; in other cases, it is because the service is not covered by the NHS, for example, medical reports for insurance companies.
Surely the doctor is being paid anyway? It is important to understand that GPs are not employed by the NHS, they are self-employed, and they have to cover their costs - staff, buildings, heating, lighting, etc - in the same way as any small business. The NHS covers these costs for NHS work, but for non-NHS work the fee has to cover the doctor's costs.
What is covered by the NHS and what is not? The Government's contract with GPs covers medical services to NHS patients. In recent years, more and more organisations have been involving doctors in a whole range of non-medical work. Sometimes the only reason that GPs are asked is because they are in a position of trust in the community, or because an insurance company or employer wants to be sure that information provided is true and accurate.
Examples of non-NHS services for which GPs can charge their NHS patients are:
Examples of non-NHS services for which GPs can charge other institutions are:
Is it true that the BMA sets fees for non-NHS work? The BMA suggests fees for non-NHS work which is not covered under a GP’s NHS contract, to help GPs set their own professional fees. However, these fees are guidelines only, not recommendations, and a doctor is not obliged to charge the rates suggested. You can read more here about BMA suggested fees.
Why does it sometimes take my GP a long time to complete my form? Time spent completing forms and preparing reports takes the GP away from the medical care of his or her patients. Most GPs have a very heavy workload - the majority work up to 70 hours a week - and paperwork takes up an increasing amount of their time, so many GPs find they have to take some paperwork home at night and weekends.
I only need the doctor's signature - what is the problem? When a doctor signs a certificate or completes a report, it is a condition of remaining on the Medical Register that they only sign what they know to be true. In order to complete even the simplest of forms, therefore, the doctor might have to check the patient's entire medical record. Carelessness or an inaccurate report can have serious consequences for the doctor with the General Medical Council or even the Police.
What will I be charged? The BMA recommends that GPs tell patients in advance if they will be charged, and how much. It is up to the individual doctor to decide how much to charge, but the BMA produces lists of suggested fees which many doctors use. Surgeries often have lists of fees on the waiting room wall based on these suggested fees.
What can I do to help? Not all documents need signature by a doctor, for example passport applications. You can ask another person in a position of trust to sign such documents free of charge.
If you have several forms requiring completion, present them all at once and ask your GP if he or she is prepared to complete them all at once as a 'job lot' at a reduced price.
Do not expect your GP to process forms overnight: urgent requests may mean that a doctor has to make special arrangements to process the form quickly, and this will cost more.
If you are travelling outside Europe, North America or Australia / New Zealand, you are likely to need preventive health advice specific to the countries you are visiting; this needs to be accurate and up-to-date and can be obtained from the following numbers (Please note that calls will cost at least 50p per minute):
The Hospital for Tropical Diseases – 0906 133 7733 Liverpool School of Tropical Medicine – 0906 701 0095 Malaria Reference Laboratory – 0906 550 8908
The practice nurse is happy to give advice, by appointment, on vaccination and other health requirements for foreign travel although patients may need expert travel advice from the specialists at Liverpool School of Tropical Medicine if the travel itinerary is intricate or has multiple destinations.
If you require travel vaccinations please download and complete the Travel Vaccination Questionnaire and bring or fax it to the practice when you book your appointment.
Once specialist advice has been obtained, the vaccinations can be administered, at the traveller’s discretion, either by Liverpool School of Tropical Medicine, who may charge a fee, or by Tracey Peet, our Practice Nurse, free of charge.
Please note that it is the travel advice itself that requires the expertise not the actual vaccination(s).
You can obtain travel and travel vaccination advice from the Department of Health’s own travel advice website onhttp://www.nathnac.org/index.htm
Another useful travel website can be found at http://www.fitfortravel.nhs.uk/ which is a public access website provided by NHS Scotland.
For a small fee, you can obtain a full and informative travel health brief personally designed for travellers from the Masta Travel website http://www.masta-travel-health.com
Following appropriate assessment, vaccinations will be scheduled. Please note there is a charge for Yellow Fever and for certain other vaccinations that are not routinely provided by the practice.
For some courses of treatment to be effective they need to be started several weeks before travel - please don’t leave making an appointment to the last minute. Ideally travel vaccination should be completed at least 6 weeks before travel but a minimum of 4 weeks notice is required. If you give us less notice than this we may try to accommodate you, however, much will depend on the Practice Nurse’s work load and the complexity of your travel itinerary. Please be prepared to be told to attend the Liverpool School of Tropical Medicine instead.
For those patients with complex itineraries or for those working abroad for longer than 3 months it can be very difficult to work out the appropriate vaccinations and you may need to attend the Liverpool School of Tropical Medicine.
Patients giving less than 1 week’s notice will need to attend the Liverpool School of Tropical Medicine.
Malaria is a dangerous tropical infection against which you will need to take precautions before travel.
We will provide private prescriptions for malaria tablets following a telephone consultation with your GP. Before making an appointment for a telephone consultation you should:
There may be a fee for the private prescription.
Garswood Surgery is a designated WHO Yellow Fever Vaccination Centre.
Yellow Fever vaccine is very effective against this deadly disease. It protects you from 10 days after the vaccination, and is administered in a single injection. It is vital that you have this vaccination for all areas where the disease occurs. The current advice is to have the vaccination repeated every 10 years.
In countries where there are mosquitoes that could transmit the virus, actual documentation is required before you can obtain permission to enter the country, which states that you have been vaccinated against yellow fever. This can only be provided by a stamp in the yellow international vaccination card issued by a WHO recognised vaccination centre.
You do not need to be a patient of Garswood Surgery for us to vaccinate you against Yellow Fever.
Important This vaccine is expensive. It has a short shelf life and so we do not stock it routinely. As it is sometimes difficult to obtain, we require notice that you need this vaccination so that we can ensure that we have supplies of the vaccine beforehand.
If you require a yellow fever vaccination please download and complete the Yellow Fever Questionnaire and bring or fax it to the practice when you book your appointment. The cost of the vaccination is £90.00
Please telephone the practice to make an appointment for your Yellow Fever vaccination at least 12 days before travelling. The staff will advise you of the current cost of the vaccination which includes the International Certificate of Vaccination.
It is possible that we would not recommend Yellow Fever vaccination to:
If necessary we will provide letters of exemption from Yellow Fever vaccination. The cost of this is £20.00.
CLICK HERE for an interactive world map which has the latest information about the country situation with respect to yellow fever vaccination requirements and recommendations and malaria risk and prevention.
We recommend you use anti-mosquito measures and take out Travel Insurance. If you have a medical condition, you should inform the Insurance Company about this.
Obtaining travel insurance for Cancer Sufferers can be very difficult. InsureCancer’s sole purpose is providing specialist insurance to those affected by Cancer. To find out more about this award winning insurance underwriter please click here .
Travel insurance provides vital protection against the risk of incurring large medical bills should you require emergency medical treatment abroad, however, many insurance companies refuse cover to people with existing medical conditions. Unfortunately, for a small number of people it is entirely possible that travel insurance could cost more than their holiday, but it’s important to remember that you are insuring yourself and not just your holiday.
Travel insurance provides medical insurance cover whilst you are away, protecting you from the risk of incurring large medical bills if you require emergency medical treatment. Never risk travelling uninsured. Emergency medical treatment abroad and air ambulance transport back to the UK can quickly amount to many thousands of pounds - a cost that many people could not afford to pay.
There are many providers of medical insurance for travellers with complex medical histories. Check online and get a quote that best meets your circumstances.
Even for those with severe medical conditions there are ways to minimise the cost of your travel insurance. Below are some tips about how to keep the cost of travel insurance as low as possible
The destination country can affect the price of travel insurance. For instance USA, Canada and the Caribbean are generally the most expensive holiday destinations to get travel insurance for, with cover costing as much as double what it would for an alternative destination. This is due to the expense of obtaining medical treatment in these countries. Avoiding these destinations can significantly reduce the cost of travel insurance.
Even within Europe the price can vary, with Spain often proving more expensive than Greece or Italy. Therefore, if you are looking for a relaxing beach holiday but are not fixed on a particular destination, try getting some travel insurance quotes for different destinations before you book. In terms of insurance, a trip to the Maldives could be significantly cheaper than a trip to the Caribbean.
Don’t be surprised that travel insurance for a 2 week holiday could well cost double what it costs for a 1 week holiday.
The most important part of a travel insurance policy is the cover it provides for emergency medical treatment abroad, but most policies also include a range of other benefits which although useful are not as important. For instance, personal possessions may already be covered by home contents insurance or, if the holiday is not too expensive or you are travelling imminently, cancellation cover may not be necessary, therefore the cost of travel insurance can be kept down by only buying absolutely necessary cover, ie., emergency medical and repatriation cover.
The St Helens Council Adult Social Care & Health Department are currently developing a new service for people 55 years and over who live in the borough of St Helens. This service allows you, or your representative, to complete a simple "self assessment" form to help you to consider your needs around issues that can sometimes effect older people such as benefits, housing, minor aids & adaptations, transport etc. The information and advice provided by the Self Assessment Team can help you to self-direct your care.
Click here for more information and links to download forms. (Opens a new window)
Blood Pressure Monitoring by Health Care Assistant
This service is not routinely available for patients on medication for high blood pressure.
Our Health Care Assistant is able to take your blood pressure, although she is not trained to discuss your blood pressure reading with you. She acts on the readings they take within a strict protocol devised by the GPs. Any follow-up action that may be needed is dealt with by the GP or nurse.
The reception staff will be able to tell you when your next blood pressure check is due.
You do not routinely need to see a doctor to have a blood pressure check.
The following patients are eligible to have a blood pressure check conducted by the health care assistant:
The practice nurse is available for advice regarding contraception. She also carries out “pill checks” for women who are taking the contraception pill and can also give depo-provera injections. Dr Helen Parr is fully trained and qualified for fitting contraceptive implants and coils.
For comprehensive information about contraception and sexual health visit the Family Planning Association website.
Emergency contraception (the ‘Morning After Pill’) can be obtained from St Helens Walk in Centre. Some local pharmacists are trained to give the emergency pill, however, if they are not available that service cannot be guaranteed.
How effective is the emergency pill?
It is very effective and is more effective the sooner it is taken after sex. However, it is not as effective as using other methods of contraception regularly and does not protect you against sexually transmitted infections. Of the pregnancies that could be expected to have occurred if no emergency contraception had been used the emergency pill will prevent:
Family Planning Clinics
The family planning clinic for our area is:
Haydock Health Centre Station Road Haydock St Helens WA11 0JN
The clinic opening time is: Tuesday 5:30pm – 7:30pm
Tel: 01744 733501
Leaflets for Downloading
Community Sexual Health Clincs (Family Planning Clinics) Teenage Sexual Health Clinics (Family Planning Clinics)
We are keen to encourage everyone who wishes to increase their exercise to do so, especially if you have medical problems that would benefit from improved physical fitness.
We mainly refer people to Ashton Leisure Centre, Old Road, Ashton (tel. 01942 732642). The Active Living Officer will carry out a ‘health and lifestyle assessment’ and talk to you about the types of physical activity you might enjoy.
Please ask your doctor or nurse about an exercise referral.
We are always keen to encourage and promote exercise for all its health and other benefits. The British Heart Foundation also provides advice on how you can help keep your heart healthy.
A free and confidential sexual health service.
For an appointment call: 01744 458383.
The Government have asked us to offer a free NHS Health Check to people who are aged between 40 and 75 years with no existing history of diabetes, heart disease, high blood pressure, stroke or chronic kidney disease.
Most people who qualify for this free health will receive an invitation by letter although those who are in receipt of regular medication will be offered the health check at the time of their medication review, usually during the month of their birthday. Some people will be invited opportunistically should they visit the practice for some other reason and a health check is indicated.
The health check involves completing a health questionnaire and an appointment with the health care assistant for a fasting blood test for Cholesterol and Glucose and to have some basic measurements such as height, weight, blood pressure, etc, recorded.
The results of the questionnaire, blood tests and measurements will be checked by a GP who will assess the risk of developing stroke, diabetes or heart disease and, should it be necessary, provide personalised advice and support to help reduce that risk.
Click here to download our health check questionnaire
At Garswood Surgery a one-to-one counselling service is available following assessment by the GP.
This service is specifically aimed at the management of mild to moderate depression and anxiety/stress disorders.
If you feel you might benefit from this service please arrange an appointment with your GP.
This service is managed by the Primary Care Mental Health Team. There is currently a waiting list of approximately 4 – 6 weeks for an initial assessment by the counsellor.
We offer a practice based phlebotomy service with Julie, our Health Care Assistant. Her clinics are as follows:
Monday (8am-11.50am) Tuesday (8am-11.50am) Wednesday (9am-11.50am) Thursday (8.30am-11.50am)
Please note that she does not have a clinic Phlebotomy clinic on a Friday morning.
This service is available by appointment. You must be a patient of Garswood Surgery to attend these clinics.
There is also a Community ‘drop-in’ phlebotomy service each Monday morning (9am-10.45am). This service is not appointments based and is offered on a first come first service basis. This is not a practice based service and operates from the top floor of the health centre. This service is available to anyone, regardless of whether or not they are a patient of Garswood Surgery.
Please ask at reception about these and other facilities which are available for taking bloods.
Fasting Bloods Please note for some blood tests you may be required to fast. Where this is the case you should not have anything to eat for 12 hours before your blood test is due. You should however drink plenty of plain water when fasting. You must take any prescribed medication as normal, unless advised otherwise by your GP.
There is a community podiatry service every Friday morning.
This service can only be accessed through a GP referral.
As the Podiatry Service pressures are increasing, the waiting time for an initial assessment appointment will be prioritised and determined by an individual’s clinical need. The current waiting list for this service is approx 3 months. If you have been referred for podiatry and have not received an appointment within 6 weeks you should ring 0151 290 2000 between 10am – 12pm & 2pm – 4pm.
Please do not ring the surgery to make enquiries about podiatry appointments as we have no control over this service or over how appointments are allocated.
An NHS Podiatry (Chiropody) initial assessment is available to the following persons:
These are special clinics dedicated to providing treatment room services such as dressings, removal of sutures (stitches), ear-syringing, etc.
Click here to see the full range of services, clinic venues and hours of opening.
If you require language interpretation this can be arranged by appointment. Please advise the receptionist.
If you require deaf interpretation services this can be arranged by appointment. Please advise the receptionist.
If you require information to be provided in large print or Braille please let us know.
If you require our practice leaflet to be supplied in a different language please let us know.
Smokefree St Helens is pleased to provide a new drop-in session offering St Helens residents/workers support to help them to quit or reduce their smoking. Open 6 days per week Monday – Friday 11 -1pm, and Saturday 10-12, these new sessions are based in Unit 12, St Mary’s Indoor Market which can be located by entering the market near to B&M’s. A private area has been sectioned off within the stall to ensure confidentiality.
NHS Stop Smoking Service - Drop-In Sessions - No Appointment Needed To find out more about the St Helens Stop Smoking Service visit http://www.bridgewater.nhs.uk/haltonsthelens/stopsmokingserviceTo print out an information leaflet about the St Helens Stop Smoking Service (including information about current drop in clinics throughout the area) click here. To see a list of current St Helens Support drop in clinics click here.
Stop smoking and the body will begin to repair the damage done almost immediately, kick-starting a series of beneficial health changes that continue for years.
Withdrawal symptoms are the physical and mental changes that occur following interruption or termination of drug use. They are normally temporary and are a product of the physical or psychological adaptation to long-term drug use, requiring a period of re-adjustment when the drug is no longer ingested. In the case of smoking, some of these are:
There are many websites which you can visit which can inform about the dangers of smoking and about the support available to people who want to quit. Below are a sample some useful websites – just click the links to find out more…
http://www.quit.org.uk/so_you_want_to_quit.pdf http://www.bhf.org.uk/giveup/alternative_methods.asp http://www.ash.org.uk
A community care assessment is the means by which a local authority decides if you are in need of community care services.
The single assessment process will include such things as your health, housing, whether you have enough money to live on, how you cope with daily living tasks such as washing and bathing and the preparation of meals. It should also take into consideration your psychological needs, for example, what you think and feel.
It will also look at what sources of help the person needing care already has access to, such as carers, family, or nearby friends, and their willingness to continue providing care.
If it is decided that you do not require support from your local council, the social worker should give you a copy of your Needs Assessment. If, however, it is decided that you do require support from your local council social services, these needs should be in writing on a form; this is known as a Care Plan. This Care Plan should state each of your individual needs, how they are to be met, details of when and who will be meeting them, and why they need to be met.
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