Starting a Private Practice

Starting a private practice requires significant planning and a measure of business acumen. Since doctors are often untrained in the relevant business processes, we have endeavoured to provide a broad overview of the steps involved in setting up a private practice to help you get started.

Bear in mind, however, that the implementation and ultimate success of your practice will likely require you to do deeper research.

IF the process can seem daunting, some Practice Management Bureaus can assist doctors with starting and managing their private practices.

Still, getting a broad grip on what a private practice entails would be a wise first step. So, put your (likely underutilised) business cap on, and let’s get started!

(Please see the table of contents in the sidebar to help you navigate your way through this page)

13 Steps To Starting A Private Practice

Step 1: Business Plan

Develop a business plan!

Many doctors fail at this first but very important step of the process. A business plan will not only help you to secure funding where necessary, but also to ensure that you have considered and weighed up all the materials and resources required before building this ship.

Important aspects to include in your business plan:

The patient profile you wish to serve.
The services you wish to offer.
Whether you will be dispensing medication.
Whether your practice will be cash-based, medical-scheme based, or both.
The demographic location of your practice (considering the above).
Adequate research of potential competitors in the area.

Step 2: Registrations

But first, the legal requirements!

HPCSA

Make sure your registration with HPCSA as an independent medical practitioner is up to date.

BHF

Register with BHF (Board of Healthcare Funders) for a PCNS (Practice Code Number System) number. This will essentially be your practice number. You will need to make a small annual payment to BHF for your registration with them for as long as you continue to practice with your practice number. The application forms and instructions can be found by following the link above. If you plan to utilise the services of a practice management bureau to manage your practice then you can easily ask them to assist you from this step already.

Every practicing doctor needs to do so under a practice number. If you are working as a locum, at a hospital, or even joining another practice, then you are using the practice number of the facility where you are working. Therefore, if you wish to practice independently then you need to register with BHF and get your own practice number.

CIPC

Register your practice as a legal entity (i.e., a business). You can either register directly at CIPC (Companies and Intellectual Property Commission), or you can ask a ‘middle-man’ to assist with the registration process. If you do not have experience with business terminology and specific legal requirements, it is advisable that you first consult with a professional in this regard as the business registration of your practice could have massive tax and other ramifications. For this reason, you might want to ask your practice management bureau or accounting firm to assist you, whichever you will be using in the management of your practice.

It is also advised that you first read the HPCSA’s Policy Document on Business Practices so you can make informed decisions when registering your practice as a legal entity.

Step 3: Business Bank Account

It’s never too soon to open your business bank account.

Here are some important things to look at (besides the monthly bank fee) when deciding on which bank to use for your practice:

Interest rates

This is especially important if you will be taking out a loan to help fund the start-up of your practice.

Benefits and services offered specifically to doctors

Practice management software packages.
Financial advice.
Private bankers willing to respond at all hours of the day.
Medical malpractice and indemnity insurance packages.
Credit card device options and fees (at the point of payment at your practice).

Step 4: Dispensing License

Did you decide to open a dispensing practice?

Then you will need to start working on getting your dispensing license. The first step is for you as the practitioner to complete a dispensing course with an entity that is accredited by the South African Pharmacy Council (SAPC). Since this takes some time, it is advisable to start working on this already at this point.

Once you have completed the course, you can apply for the dispensing license (after step 5). Click here for more information regarding the dispensing course and license.

Step 5: Building, Furniture, Electronics

Time to get down to business…

By this time you have done a good amount of research and decided where you want to start your practice. The next step is to secure a building.

Decide whether to rent or buy. It would be a good idea to discuss these options with your financial advisor if you have one. It is also worth considering buying an already-established practice from another practitioner wishing to sell their practice. In that case, many of these steps might become redundant.

Once you have a building, you will have a better idea of what furniture would be best according to its layout. And remember the electronic equipment!

Below are lists of some things to consider regarding each of these points.

The building

1. Location:

Easy access (perhaps on or adjacent to a main road).
Visualisation (make sure people know you are there).
Parking.
Population demographics (to align with your services and type of practice).
Safety.
Proximity to support or related medical services (pharmacies, clinics, hospitals, paramedic services, etc.).
Access to fibre if possible.

2. The building:

Reception area.
Bathroom.
Staff bathroom (if possible).
Area/basin to scrub for procedures.
Easy access for patients with difficulty mobilising (e.g., ramp, smooth path for wheelchairs).
Consultation room with enough space and privacy.
Procedure/emergency room (can be convenient).
Room for the nurse (where applicable).
Green area (kitchen, private place of rest for staff).

The furniture

1. Waiting room:

Couches/chairs.
Coffee table.

2. Reception:

Desk or counter.
Chair(s).
Filing cabinet for documents and stationery.

3. Consultation room:

Desk.
At least 3 chairs (one of which is for you).
Cupboard/chest of drawers for documents, stationery, pamphlets, and trinkets.
Bookcase for documents, books, etc.
Examination bed.
Bedside table/space to place things when examining or doing procedures.
Bookcase/tiered stand for examination equipment, emergency medicine, etc.

The electronics

Computer(s).
- Reception area.
- Consultation room(s).
Internet access.
Printer/copier/scanner.
Telephones.
- Reception area.
- Consultation room(s).
- Private telephone network (to communicate within the practice).
Point of payment device.
Generator or backup battery (to keep online processes ongoing during load-shedding, let’s face it).

Step 6: Appliances, Equipment, Medicine

Finally, some more exciting stuff…

Appliances and Equipment

There are various medical appliance and -equipment suppliers that are happy to help doctors kit out their new practice. You can consider renting the larger or more expensive appliances (like ultrasound machines) or even purchasing them second-hand. The cost of medical equipment and appliances can be significant, so make sure you did your research when setting up your business plan so that your capital or loan will be sufficient.

Below are lists of appliances and equipment that you are required to have in your practice. Please note that the lists are not comprehensive.d

Appliances and equipment required for emergencies

ECG machine.
Oxygen port or cylinder.
Defibrillator.
Ambu bags.
Endotracheal tubes.
Laryngoscopes.
Suction device (manual or electric).
Nebuliser.
Infusion sets.
IV fluids (0.9% saline, etc).
IV cannulae.
Drip stand.
Strapping.
Cord clamps, etc.

Other appliances and equipment required

Baumanometer (manual or automatic) with different cuff sizes.
Pulse oximeter.
Glucometer.
Thermometer.
Haemoglobinometer.
Ophthalmoscope and otoscope.
Urine testing strips.
Pregnancy tests.
HIV rapid testing kits.
Substance tests.
Tongue depressors.
Scale.
Gloves.
Dressings.
Plaster of Paris casts.
Crepe bandages.
Urethral catheters.
Autoclave and UV steriliser.
Procedure equipment:
- Needle holder.
- Stitch scissors.
- Artery forceps.
- Pincettes.
- Surgical blade holder.
- Cutting scissors.
- Suturing material.
- Syringes.
- Hypodermic needles.
- Webcols/cotton wool.
- Tourniquet.

Some other helpful equipment and appliances to have

Cholesterol meter.
Electrocautery set.
Snellen chart.
Liquid nitrogen or another cryotherapy tool.
Glue stitch or steri-strips.
Specialised wound dressings.
Resin casts.
Splints for fractured limbs/digits.
Crutches.

Medicine

Whether or not you will be a dispensing practice, you will still need some medicine at your practice (e.g., emergency medicine, analgesics, local anaesthetics, etc.). For all your pharmaceutical needs, you can easily create an account with a pharmaceutical wholesaler and distributor close to you, e.g., Transpharm, Aptekor, etc.

Once you have an account you can submit your order to them (usually online), and they should deliver the order to your practice within about 24 hours (depending on the wholesaler). While it is helpful to set up the account at this point, it would be advisable to only purchase the medication shortly before opening up practice for the sake of preserving the medicine.

Below is a list of drugs that you are required to have in your practice. Please note that the lists are not comprehensive.

Emergency medicines

Adrenaline.
Aspirin.
Atropine.
Beta-adrenergic solution for nebulisation.
Dextrose 50%.
Diazepam or Lorazepam.
Hydrocortisone.
Induction agent (e.g. Ketamine).
Muscle relaxant (e.g. Succinylcholine).
Water for injection/normal saline, etc.

Other helpful medicines to have

Anti-emetic (IM).
Anti-hypertensives for severe hypertension or hypertensive urgency (PO).
Anti-pyrexial, especially for children (PO or PR).
Anxiolytic (IM or PO).
Ceftriaxone (IM).
Benzathine benzylpenicillin (IM).
Cortisone (IM, IA, or PO).
Paracetamol, Diclofenac, or any other fast-acting anti-inflammatory or analgesic (PO, IM, or IV).
Lignocaine, plain and with vasoconstrictor (local anaesthetic).
Vitamin B12 and vitamin B complex (IM), etc.
Local anaesthetic eye drops.
Family planning injection/depo.
Topical anaesthetic ointment or gel, etc.

Step 7: Professional and Practice Insurance

Keep yourself covered.

Now that you have the building and its contents, it’s time to look at insurance. There are 2 types of insurance to consider:

1. PERSONAL LIABILITY INSURANCE

a. Professional liability insurance.

- Malpractice insurance.
  - In the event that someone files a lawsuit based on your medical management.
- Indemnity insurance.
  - In the event that someone files a lawsuit based on a breach of professional conduct, e.g., breach of confidentiality.
- It’s imperative that you get professional liability insurance before practising in the private sector at all.
- Some personal professional insurance companies available:
  - MPS.
  - AON.

2. BUSINESS INSURANCE

a. Building and content insurance.

- - In the event of theft, natural disaster, damage to property, etc.
  - HIGHLY recommended, if not compulsory.

b. Product liability insurance.

- - In the event that someone files a lawsuit against your practice due to damage caused by your equipment, medication, or appliances, e.g., consequences from using expired medicines.

c. Public liability insurance.

- - In the event that someone files a lawsuit due to an injury sustained from slipping or falling at your practice.

Since you might not need all of the above, we recommend that you start off by speaking to a reputable business insurance provider, preferably one that specifically caters to private medical practices (like Old Mutual Insure), and hear what they have to say about what your practice would need.

Step 8: Branding

We bet you didn’t see this one coming!

Branding might seem like a random or redundant step, but believe us, it is important! Your patient basis will not grow unless people know about your practice and like what they see, which in turn will affect the ultimate growth and success of your practice.

If you have the financial means, strongly consider getting a professional marketer to help with your branding. This will include things like a practice logo, a colour scheme/palate, emphasising your competitive value, marketing, and potentially developing a website for your practice (especially if you want your practice to offer services beyond that offered by you as a GP, for example allied health, etc.).

Make sure to check the HPCSA guidelines provided in Booklet 2 and Booklet 16 when busy with this step!

Step 9: Practice Management Software

Now we get to the good stuff: technology!

Modern practice management software has largely revolutionised how a practice gets run. While some older general practitioners still use paper-based systems, there is great value in investing in a good practice management software package from the start!

These software programmes can range from merely assisting with your billing and claim submission, to allowing you to create a comprehensive profile for each patient that integrates with their radiology reports, laboratory results, referrals, letters from other healthcare practitioners, previous medication prescribed, digital scripting, digital sick certificates generated, etc.

These practice management software solutions have the potential to not only make your practice more time-efficient on all fronts but also greatly improve patient management and continuity of care. It is worth seriously weighing up the cost vs benefits of the different packages according to your practice needs.

For more information regarding patient records, consult the HPCSA guidelines provided in Booklet 9.
For more information about some of the best Practice Management Software Solutions in South Africa, click here.

Step 10: Staff

Get help to run your practice smoothly.

Staff to consider hiring, either on a full-term or part-time basis:

Receptionist (quite necessary full-time).
Finance and accounts manager.
- Accounting firms and practice management bureaus tend to offer these services (see step 9).
- Otherwise, you can employ someone full- or part-time, depending on the size and requirements of your practice.
Nurse or sister (very helpful and opens up many more services to offer).
Cleaner.

NB! If you hire staff you must adhere to the Labour Law requirements, only one of which is to have a poster up with the latest Labour Laws visible to your staff members at all times. Such posters can be purchased online to place in your practice.

Also take a look at the Basic Conditions of Employment Act (SAICA) and the Occupational Health and Safety Act (OHSA) to get an idea of the requirements, or consult a labour relations practitioner or lawyer.

Step 11: Radiology and Pathology

Don’t forget the necessary investigations.

PathCare.
Ampath.
Lancet.

You will also need to register with radiological services in your area. Many of these can be found at hospitals near you, some also existing as their own practice entities. It would be preferrable to register with one that offers online reporting for quick and easily accessible results.

It is your choice whether you want to register with more than one of each of the above. Perhaps start by registering with one and decide whether you need to register with any others once you have started seeing patients.

Step 12: Medical Aids

We need ’em, folks!

This step depends largely on whether your practice will be cash-based, medical aid based, or both. Most practices function with a combination of the two. This makes it very important that you register with medical aids – otherwise, you will not get paid! If you’ve signed up with a practice management bureau to help manage your practice then you can ask them to assist with this step. Otherwise, we at SAdocs can assist you with this step, so send us a message!

So…how do we as healthcare practitioners relate to Medical Aids?

As a healthcare provider, it is important to remember that you have a relationship with the patient, not their medical aid. You are not providing a service to the medical aid, but to the patient. This should always take priority and your treatments should always be in the best interest of the patient.

Submitting claims on behalf of your patients is an added service offered by most GPs and many specialists, and is widely appreciated (and often assumed) by patients. Some practices, however, prefer to have their patients pay them on the day and then claim from their medical aid themselves. Although this might seem like an easier option, it could affect your ‘business’ if there is another practice close by that makes their patients’ lives that much easier by submitting their claims. Submitting claims yourself can also give a bit of extra time for you to make sure you submit all the relevant codes for the consultation.

This brings us to the next point. Every claim submitted to a medical aid needs to include the following (besides the patient details):

ICD 10 diagnostic code(s)
- There are many apps and websites where you can look up ICD 10 codes, even Google!
Consultation code(s)
- Once you have registered with a medical aid you can usually find the list of consultation codes on their website or ask them to send it to you via email.
Procedure code(s)
- This code is to indicate any specific procedures that were done. This can include anything from blood drawn to surgery.
- You can also find the list of procedure codes from a medical aid you have registered with.
Material code(s)
- This is for all material used during your consultation (including medicines) and/or procedures. For example, if you sutured a wound then you submit the codes for the local anaesthetic, suturing material, sterile tray, sterile gloves, dressing material, tetanus vaccine where applicable, etc.
- You can also find these codes from a medical aid.

You have surely have noticed by now that submitting claims can get quite complicated, whether done by the patient or by you. If it is done by the patient, then the invoice to be submitted must include all the above codes. If it is submitted by you, you will likely have the assistance of whatever practice management or billing software you are using (see step 9).

The Council for Medical Schemes acts as an intermediary between all the medical schemes in South Africa and the Department of Health. For a list of all the medical schemes registered in South Africa, click here.

Step 13: Miscellaneous

Almost there…

Some final things to consider as you approach starting a private practice:

Always keep your practice clean.
Make sure you have organised for proper waste removal. This includes the removal of medical waste and sharps. You must be able to provide your agreement documents with your dedicated waste-removers, as well as a summary of your annual waste (which will be provided by them). For more information consult the HPCSA guidelines provided in Booklet 1 and Booklet 12.
You must keep all Schedule 5 and above medicines registered and locked away, only to be accessed by authorised healthcare personnel. All other medicines must also be inaccessible to patients except if given by you.
Consider including a written patient-doctor agreement form for all new patients. Check out the HPCSA guidelines on patient consent (Booklet 4) and confidentiality (Booklet 5).
Always have a visible sign to notify patients where they can go if you are closed, i.e., an after-hours or emergency facility nearby.
Make sure your practice is compliant with the POPI and PAI Acts by consulting the guidelines provided by the HPCSA.
Read through all the HPCSA Booklets on the Scope and Ethics of Practice that are applicable to you.
The Alliance of South African Independent Practitioners Associations (ASAIPA) might be an attractive association for some to join for a monthly fee. Each province has its own association that forms part of the national alliance (ASAIPA). Find out which association is active in your province to decide whether membership would provide the kind of support you desire as a practice owner.

Please remember that the information provided on this page is not comprehensive, but merely aims to be a guide to help you get started on this exciting journey of starting a private practice. Top it up with your own research to ensure that you have covered your bases and set yourself up for success. All the best!