The challenge
The client operated a private healthcare group with 12 clinic locations across the UK and Ireland, offering dental, dermatology, and aesthetic services. Each location ran its own bookkeeping: three on QuickBooks, six on Sage, two on Xero, and one on a spreadsheet updated weekly by the practice manager.
There was no consolidated P&L. The CFO closed month-end by hand — exporting from each system, normalizing the chart of accounts, reconciling intercompany transfers. The full close took 14 days, delivering numbers too late to act on.
The errors had real cost. Inter-location supplier invoices were miscoded. Patient refunds were recorded in three different accounts depending on which clinic processed them. The external auditor found seven material adjustments at year-end and signaled the next audit would go worse.
The solution
Chart of accounts first
We designed a single standardized chart of accounts for all 12 locations: location-coded cost centers, a unified treatment-revenue taxonomy across the three service types, and a clean intercompany structure. The CFO and the external auditor signed off on the template before any migration began.
Three migration waves
All 12 locations moved to a single Xero instance with location-tagged tracking categories, in three waves of four locations, each wave taking about three weeks: extract, normalize, reconcile opening balances, run in parallel for one period, then cut over.
- Wave 1: the two existing Xero sites plus the two cleanest Sage sites — used to pressure-test the chart of accounts in production.
- Wave 2: the four QuickBooks sites — the trickiest mapping, though the data was reasonably clean.
- Wave 3: the four remaining sites, including the spreadsheet location and the two messiest Sage instances — the slowest wave, with buffer built in.
The thing that nearly went wrong
During Wave 2, we discovered one location had been booking patient refunds against revenue instead of a refund liability for nearly two years. The cleanup pushed that wave a week over. We rebuilt the prior-year comparatives at the same time to keep the audit trail clean — which the CFO later called one of the most valuable deliverables of the engagement.
Weeks 12–14: Pod handover
The patchwork of local bookkeepers was replaced by a daily transaction-processing pod in our delivery center: invoice coding, bank reconciliation, supplier payments through Telleroo, and patient refunds against a single liability account. A senior accountant owns month-end close, working directly with the client's CFO.
What ongoing looks like
Daily transaction processing across all locations. Month-end close in five business days, consolidated P&L on day six, location-level management accounts the same day. Quarterly reviews with the CFO and auditor keep the chart of accounts intact as the group grows — three more clinics are on next year's roadmap, and onboarding a new site now takes two weeks instead of being a year-long project.