Case Studies

An underperforming multi-doctor specialist practice outsources management and administrative services

Improving resilience, efficiencies and the bottom line.


This highly regarded multi-doctor specialist practice with five consulting suites, 20 doctors and 24 staff had organically evolved over two decades.

Patient numbers and size of referral base had enjoyed successful growth. Yet there were concerns that the business could be doing a lot better and the current administration team were over stretched. Problems included:

  • Lack of an efficient payroll system
  • A failing medical billings process
  • An expensive and inefficient transcription system
  • Lack of clear business strategy and decision making processes.


Despite being leaders in their fields, the Directors were advised by accountants that things could be performing much better, and indeed, problems with administrative efficiency and a lack of business agility were identified.

The challenge was to:

  • Benchmark administration operations and improve processes
  • Deliver improved profitability
  • Allow the practice to modernise and take advantage of technological advancements.

This is a common issue with medium and large sized practices set-up without a rigorous approach to business or sufficient staff capabilities and training. In this case, there was $13M of transactions per year and a $2M payroll but not a single experienced or qualified Manager. It’s little wonder they couldn’t get benefits from increased size.

The practice had tried a Business Manager who didn’t know a great deal about medical practice management and failed to deliver any improvements over a 12 month period and spend of over $100k.



On advice from their Business Advisor, we were selected for our breadth of experience and achievements in several similar businesses. Our insights and experience in practice operations come from a doctor/practice manager/HR/administrator and business strategy perspective. We also have internal systems and products we can plug in and play to address the exact issues they faced, like lack of an efficient payroll system, a failing medical billings process and an expensive and inefficient transcription system.

We approached the problem as one of optimising patient care, improving patient experience and enhancing the career development and performance of staff and doctors – because we know how doctors work.



We provided a long-term in-house solution – not a 6-month arms’ length consultancy – with a promise to see things through by way of a 3-year plan with KPIs set for each year. Our solution was implemented as follows:

  • Establish buy-in from all directors and staff
  • Draw up scope of works and business priorities
  • Perform GAP analysis over a 3 week onsite deep dive into processes, finances, contracts, and business operations
  • Provide proposal of services to Directors
  • Apply routine change management principals designed to work in a medical practice (respecting need for doctors and patients to interact successfully during change).
  • Consideration of all possible solutions for the practice by two Hoxton Practice Managers and our Senior Project Manager with input from Billings, Bookkeeping and Transcription Teams. Options other than Hoxton were also discussed and compared.
  • Delivery of a detailed 18 page report to Directors with problems identified and solutions mapped out for consideration and prioritisation.

This included review and improvement in all aspects of business operations with:

  • New technology that makes life easier all round
  • Full time Hoxton MPM Manager on-site to deliver outcomes
  • Plugged in standalone services to solve problems:
    • Hoxton Billings
    • Hoxton Payroll using Tanda
  • Support and training of the current Practice Manager to improve effectiveness.


As well as Improved profit and reduced costs, we’ve increased resilience and efficiency by removing single points of failure – like a practice manager who is omnipotent, but lacks capability as a manager.

We embedded clear organisational Policies and Procedures and the client is now invigorated to have:


“As doctors, we have limited ability to think of all the important things required to make good business decisions. Having experienced advice from an organisation like Hoxton, set-up entirely to meet our needs and from a doctor’s perspective, is the only sensible way forward. The ability to commit to joining us on the journey, and provide plug-in solutions is invaluable”.


Improving resilience, efficiencies and the bottom line.


We keep your practice running smoothly, so you can focus on your most important work.