• Organisational structure

    For a practice to work efficiently and effectively, it is important that each person is fully aware of his or her role and is clear what responsibilities they should assume. A sound organisational structure is the best beginning.

    You will certainly have some administrative staff and there may be more than one medical practitioner and/or principal/partner in your practice. If you have more than one principal or partner, it is likely that you will need to make staffing and other decisions together.

    You need to design an organisational structure that will:

    • Ensure there is easy and efficient communication between all staff and patients
    • Facilitate the provision of quality service
    • Ensure patients are fully informed about services they receive, the cost to them and the expectations they may have (whether realistic or not)
    • Ensure continuity of the practice if anyone should go on leave, fall ill or cease their relationship with the practice.

    The position descriptions (see Recruitment and selection) developed for recruitment should continue to be used after staff are employed. Referring to them at regular intervals as part of the performance management system allows each person to maintain clearly-defined roles and responsibilities. In the initial stage, and whenever you recruit new staff, it is a good idea to monitor the workability of the structure you have chosen. This can be done at your regular management, general staff and individual meetings.

    Improving your practice


    The organisational structure needs to show clear lines of responsibility and communication. Keep it simple. You need to have a senior person such as a practice manager to ensure all tasks and functions are allocated and undertaken effectively. This person manages the remaining team functions. In a small practice, this may mean there is a practice manager and just one or two other staff.

    If there is more than one principal/partner, decide who will be responsible for which parts of the business, when joint decisions are mandatory and when autonomous decisions can be made. This should be documented in some way.

    Establish clear, unambiguous reporting lines which outline spending authorities and decision-making parameters.

    Create an organisation that encourages and values feedback and input from all staff. Your support and administrative staff are often in the best position to notice when things need improvement.

    Establish formal communication processes (e.g. emails, office memos, communications book, regular team meetings) to ensure that must-know information is shared with all appropriate parties. Consider your patients as part of your organisational structure. Review your structure each time you revisit your business plan or when there is any change that will affect your business operations.


    Clearly define the roles of each position you have in your organisation and check them against your organisation chart. Consider how the roles will work together, check for gaps and duplication.

    Write position descriptions for each role (see Recruitment and selection), including information about:

    • Reporting lines
    • How roles provide backup for each other during unexpected absences
    • How roles should communicate from one to the other, including your own

    It is important for position descriptions to set out the expectations of the role in clear terms. It should also be made clear that other tasks may be required from time to time, which are within the competence of the staff member.

    Work through expectations with each new employee, both their own and yours. Review roles as the practice grows. Pay particular attention when there are new staff, new equipment, new systems or new legislation or other factors that may significantly affect any or all roles in the practice.

    Board of advice

    A Board of advice is an essential component of successful practice management. It normally includes an accountant, financial planner and solicitor. Its aim is to provide specialist expertise in areas where you may need professional support (e.g. accounting, law, human resources). Such a board can provide a range of views in those areas of management crucial to the success of your business. This is not usually a formal 'board' that meets regularly (this will be very expensive) but represents a pool of expertise you can access as required.