Setting up the books before a new practice opens

What a new medical or dental practice should set up in its books before the first patient: workspace, accounts, bank, VAT, patient payments, payroll.

By Achekam · 11 October 2026 · 5 min read · For Healthcare businesses in South Africa, Nigeria, Kenya

Opening a practice means a long list: registration with the professional council, the lease, the fit-out, equipment, staff, scheme and insurer arrangements, signage. The books tend to come last, set up in a hurry the week before opening, or not at all until the accountant asks for something at the end of the first quarter.

That is a pity, because the first weeks of a practice generate exactly the records that are hardest to rebuild later: the first patient payments, the deposits on equipment, the first salaries. This article sets out what to have in place in Achekam before the first patient walks in, in the order that saves rework.

Workspace, country and administrator

Register the practice as a business rather than as an accounting firm, and pick the country it operates in. That gives the practice a workspace of its own, separate books and a web address on the Achekam domain, and makes whoever completes the sign-up its administrator.

Choose the administrator deliberately. Gateway credentials and other settings are saved by an administrator, so it should be a partner or the practice manager who will be there for years, not the person who happens to be setting things up that week.

Chart of accounts and the bank account

The practice's double-entry ledger starts with a standard chart of accounts, created the moment the books first open. You can add accounts, rename them or switch them off, which makes the week before opening the right time to shape it, while nothing has been posted. For a practice, think about:

• Income you will want to see separately, such as consultation fees, procedure fees and dispensary sales.
• Costs that matter to the partners, such as locum fees, laboratory fees, clinical consumables and professional indemnity.
• Accounts you will never use, which can be switched off to keep the chart readable.

Open the practice's business bank account early and get the first statement into the books. Achekam takes bank statements in the common file formats, PDF and spreadsheet exports among them, and checks each import so that its movements carry the opening balance exactly to the closing one. The deposits and set-up costs paid before opening belong in the books too.

Plan to close each month once it is complete. Months can be soft-closed, hard-closed and locked, and a closed month refuses postings from every source, which keeps last month's figures from shifting while you work on this month.

VAT number on documents, only if registered

A VAT-registered practice records its number under Settings, Firm Profile. Only then do the documents the server produces show the number and carry the Tax Invoice heading.

A practice that is not registered leaves the field empty, and then has a job to do on every invoice: Achekam will charge VAT on a line whether or not the business is registered, so it falls to the practice to keep VAT off its lines. In Nigeria and Kenya, once the country pack is activated under Settings, Jurisdiction & regulators, each invoice line takes a tax code, and only standard lines carry VAT.

Payment options for patients

Decide how patients will pay before the first one asks.

• At reception. A practice that wants a till for patients who pay on the day needs the Point of Sale add-on; without it the till is not visible, and the server refuses its requests.
• Online, from an invoice. The practice uses its own payment gateway account. Its credentials go into Settings, Payment Gateways & Checkout, where only an administrator can save them (others may look), and the connection can be tested with a real call to the gateway before any patient uses it. Setting up your payment gateway walks through it.
• By EFT. The pay page can show the practice's bank details and a payment reference, and a staff member marks the payment received once it shows on the bank statement.

Patients billed later, or through a scheme, will have invoices followed up by credit control, which is on for new workspaces and needs working e-mail settings. Send a test invoice to yourself before the first real one goes to a patient.

Payroll employer set-up

A practice with a receptionist, a nurse or an associate needs payroll from the first month-end. Payroll starts with creating the practice as an employer, and the country rules it follows (South African, Nigerian or Kenyan) are fixed at that moment, so get the country right then.

Payroll in Achekam is a two-person job by design. Whoever prepares a run cannot approve it, and no one can approve a run that includes their own pay. In a two-partner practice, one partner prepares and the other approves; in a single-practitioner practice, the practice manager and the practitioner, or the accountant, share it.

Your accountant, from day one

Invite your accounting firm in early. You find the firm by its Achekam address or firm code, choose the role it plays for you and how much access it has, and the firm then accepts or turns down the appointment. An accountant who sees the books from the first month can catch a mis-set chart or a VAT mistake before it is repeated month after month.

If you are bringing records over from a spreadsheet kept during the set-up months, moving books off spreadsheets covers the move.

Before the first patient

1. Workspace created in the right country, with a lasting administrator.
2. Chart of accounts shaped for practice income and costs.
3. Bank account open and the first statement imported.
4. VAT number recorded, or every invoice line kept free of VAT.
5. Nigeria or Kenya: country pack activated.
6. Till in place if patients will pay at reception.
7. Gateway credentials saved and tested; EFT details on the pay page.
8. Test invoice e-mailed to yourself.
9. Payroll employer created for the right country, with a preparer and a separate approver.
10. Accountant appointed.

Good records from the first day also make tax time easier. South African practices can read SARS's guidance on record keeping, which explains who must keep records under the Tax Administration Act, which records and documents to keep, and the retention periods.

The first patient should find a practice that is ready in every way, the books included. Work down the list a week before opening, and the first payment, the first invoice and the first payslip will all land where they belong.

General guidance only, not advice on your own circumstances. Tax and payroll rules change: check the current position with the authority or your adviser.