The exciting journey of establishing an own nursing or midwifery practice requires lots of homework followed by lots of hard work to prevent the dream becoming a nightmare. Be warned, private practice is not a quick and easy way to become rich!
There are numerous successful nursing and midwifery practices in South Africa. The recipe? Good planning before take-off, followed by hard work! Of course, the first and most important requirement is that you have a number of years’ experience and are competent enough to handle your own practice and its responsibilities.
Do a feasibility study and analysis of the needs of your community for the service you want to provide. This includes looking at the profile of the population you will be serving, other professionals available in your area that you could work with or already provide a similar service (thus making the area over-traded), determinations of the local authority for running a business from home if you do not rent office space and evaluating the need for support staff.
The moment one employs staff, one has to comply with labour legislation and also to register as an employer with the South African Revenue Services for employee tax (PAYE) and unemployment insurance (UIF).
Once you have decided to set up shop, there are a number of important considerations:
Select the premises
Often private practitioners work from home at first and only move to a rented office space when their practice is up and running. If you run your practice from home and will see patients there, be sure to check with your local authority about business rights and the requirements to run a business from home.
Equipping your consulting room
Make sure that equipment is not outdated and in good working order. The consulting room must have adequate ventilation. Disposal of medical waste should be implemented according to the regulations of your local authority.
Registration with the Board of Healthcare Funders (BHF)
BHF provides one with a private practice number which should be used on all stationery, particularly on invoices and receipts. While this is not a legal requirement, it is essential to assist patients to claim from their medical aid.
Register your business with the Registrar of Companies
The Companies Act is complex and is undergoing change at the moment. Consult with a lawyer to ensure that you make the right decisions and stay within the law.
Register with the Receiver of Revenue for tax purposes
It will not be necessary to register as a value added tax (VAT) vendor at the beginning. It is compulsory for persons who make taxable supplies or services in excess of R1 million in any 12-month consecutive period to register for VAT. You may also choose to register for VAT voluntarily provided that the minimum threshold of R50,000 has been exceeded in the past 12-month period.
Record keeping is of utmost importance
Patient records must be kept complete and up to date – this is the only proof you have that you have provided care to your clients. Clear financial records must be kept and an accountant can be contracted to do this. Remember to timeously invoice your patients for services rendered.
Signage and stationery
The regulations to the Nursing Act clearly prescribe what the signage for your practice should look like. You may:
- not advertise, but can communicate in writing with clients regarding change of address and other details related to the practice
- communicate with other healthcare practitioners to inform them that you have commenced your practice
- enter your details in normal print in a telephone directory; if you are not using a cell phone for your business, ensure that the telephone at your practice has an answering service when you are not available.
- use two name plates of 360 mm x 210 mm size, indicating your title, initials and surname; registered profession and field of practice; professional qualification(s)as authorised and registered by the Nursing Council; telephone number(s) and hours of consultation. Only one name plate may be displayed at each entrance to a building in which a practitioner’s consulting rooms are situated and one on or next to the door of the consulting room. Direction indicators may be displayed in the corridor of the floor where the consulting rooms are situated.
Professional stationery should contain the name of the midwife (and partner, if any); the registered profession, field of practice and abbreviations in respect of qualifications registered by the Council; addresses and telephone numbers and hours of consultation.
If you are planning to do home births, you will require a S22A(15) permit to acquire, use, possess and supply medication. The application process is set out in the General Regulations related to the Medicines and Related Substances Act. As you will be administering the medication to your patients, you will not require a dispensing licence.
To ensure that one’s practice remains well established, one has to look after oneself. Provide for medical aid, retirement contributions, loss of earnings insurance and professional indemnity insurance. Remember too that both you as the practitioner delivering the service and your registered company can be sued in the event that something happens – make sure that you provide for both types of insurance. Indemnity insurance does not make provision for legal support for your company as well. Practise safely! For example, ask a colleague to assist you during a home birth. Access expertise in the different areas in which you need to make decisions, to assist with making the right call and informed judgements.
Time management is crucial when self-employed. One needs to schedule time to do administration, invoicing and book keeping in addition to service provision. If one is also employed elsewhere, ethical behaviour requires that one does not encroach on the employer’s time (or resources) to manage one’s own practice. The Nursing Act makes provision for the SA Nursing Council to regulate private practice. No regulations have been developed in this regard and this clause in the Act is therefore not applicable yet.