Key Takeaways
- Move from "Fixed" to "Flex": Static rosters fail under pressure. Adopting a demand-driven model that layers casuals, part-timers, and locums over a permanent core is essential for surviving peaks like flu season.
- Compliance is your safety net: Under the Fair Work Act, you generally need to provide 7 days' notice for roster changes. However, "mutual agreement" clauses are your best friend during emergencies—build a culture where staff want to say yes.
- Burnout is a business risk: With 1 in 4 primary care nurses planning to quit, protecting your core staff’s mental health is not just ethical; it’s operational. Mandate breaks and rotate "high-intensity" shifts (e.g., triage) to prevent fatigue.
- Telehealth is your overflow valve: Use telehealth not just for convenience, but as a strategic rostering tool. It allows isolating staff or those with mild symptoms to continue working safely, keeping revenue flowing.
- Data beats guesswork: Stop rostering based on "how we did it last year." Use your Practice Management Software (PMS) to analyse appointment demand by hour and day to match staffing levels to actual patient flow.
Introduction: The high cost of the "hollow" roster
In the Australian medical landscape, a "hollow" roster is one that looks full on paper but collapses at the first sign of pressure. It’s the roster that falls apart when two receptionists call in sick during the winter flu spike, or when a GP takes unexpected leave during the school holiday rush.
For practice managers and owners, the stakes in 2025 are higher than ever. With a projected national shortfall of over 100,000 nurses and tightening margins in general practice, the old "all hands on deck" approach is leading to burnout, not resilience. A roster that breaks doesn't just stress your team; it bleeds revenue through turned-away patients and increases clinical risk.
Building a resilient roster isn't about having an army of spare staff—few practices can afford that. It’s about agility. It’s the ability to stretch without snapping. This article outlines how to engineer your workforce planning to withstand the peaks without breaking your budget or your people.
1. Forecast demand, don't just copy-paste
Many practices fall into the trap of rolling over the same roster from July to August, ignoring the reality of seasonal demand.
The "Heat Map" Strategy: Your Practice Management Software (Best Practice, MedicalDirector, etc.) is a goldmine of data. Run a report on "Appointments by Time of Day" and "Turnaways" for the same period last year.
- Identify the spikes: Do you consistently get slammed on Monday mornings or Friday afternoons?
- Identify the lulls: Are Tuesday mid-mornings dead quiet?
Practical Application: Instead of having three receptionists on from 9 am to 5 pm, stagger their starts. Have one start at 7:30 am to clear the overnight online bookings and voicemail backlog, and another start at 10 am to cover the late rush. This "envelope" coverage matches staff hours to patient demand.
2. Build a "layered" workforce mix
A roster relying 100% on full-time employees (FTEs) is rigid. A resilient roster is built like a pyramid.
- The Core (Base): Your full-time GPs, nurses, and admin. They provide continuity of care and stability.
- The Flex (Middle): Part-time staff who are willing to scale up hours. Under most Awards, part-timers can agree to work additional hours up to 38 hours per week at ordinary rates (check your specific Award conditions).
- The Burst (Top): Casuals, locums, and agency staff. This is your expensive but necessary insurance policy for extreme peaks.
Real-World Example: A busy clinic in Western Sydney struggled with the 8 am "phone meltdown." They hired two university students as casuals solely for a "Tele-Triage" shift from 8 am to 10 am. This freed up the experienced medical receptionists to handle face-to-face patients, reducing wait room hostility and error rates.
3. Compliance: navigating the Fair Work Act during chaos
When the flu hits and half your team is down, you need to change the roster now. But Australian workplace laws are strict.
The 7-Day Rule vs. Mutual Agreement: Generally, Awards (like the Health Professionals and Support Services Award) require rosters to be displayed 7 days in advance. Changing a roster without notice can trigger overtime rates.
- The Solution: Most Awards allow for roster changes at shorter notice by "mutual agreement." This is where culture plays a role. If you treat staff well, they are more likely to agree to a swap without demanding penalty rates.
- The Trap: Never coerce staff into "agreeing." It must be genuine. Always document the agreement in an email or text: "Hi Sarah, confirming you agreed to swap your Tuesday shift for Wednesday. Thanks for helping out."
Fatigue Management: You have a legal duty of care under WHS laws to ensure staff are not too tired to work safely.
- Rule of Thumb: Avoid rostering back-to-back late/early shifts (e.g., finishing at 10 pm and starting at 6 am). Fatigue increases the risk of needle-stick injuries and clinical errors.
4. Telehealth as a "roster-saver"
Telehealth is often viewed as a patient service, but it is actually a powerful workforce retention tool.
The "Isolation" Shift: In a post-COVID world, staff with mild respiratory symptoms often feel well enough to work but cannot come on-site.
- The Fix: creating a dedicated "Telehealth Roster" allows a GP or nurse to work from home. They can handle script renewals, referrals, and results, keeping the revenue stream active and relieving pressure on the in-clinic team.
Scenario: Dr. Lee wakes up with a sore throat during a peak winter week. Instead of cancelling her entire day (losing ~30 appointments), the practice flips her column to "Telehealth Only." She works from home, managing 25 consults. The practice retains 80%+ of the revenue, and patients are still seen.
5. Cross-training: The ultimate insurance policy
The most fragile roster is one where only one person knows how to do a critical task (e.g., "Only Janet knows how to process the Medicare batch").
The "Matrix" Approach: Create a skills matrix for your admin and nursing team.
- Can your receptionist perform basic triage?
- Can your practice nurse handle reception billing in an emergency?
- Can your practice manager step in to sterilise instruments?
Actionable Advice: During quiet periods (non-peak), roster staff into different roles for half a day. This "paid training" ensures that when Janet calls in sick during the peak period, you have three other people who can step in, ensuring business continuity.
6. Prioritise staff wellbeing to prevent mid-peak collapse
Resilience isn't just about covering shifts; it's about ensuring your staff don't quit in week three of the crisis. 2024 data suggests widespread burnout in the sector.
Micro-Strategies for Retention:
- Protected Breaks: During peaks, it is tempting to skip lunch. Don't. A hungry, tired receptionist makes mistakes. Roster "floaters" specifically to cover breaks.
- The "No" Script: Empower your front desk to say no. Give them clear scripts for turning away non-urgent patients when the books are full. This reduces the emotional toll of dealing with aggressive patients.
- Visible Leadership: During peak times, the Practice Manager or owner should be on the floor, not in an office. Helping to wipe down a consulting room or answer a phone sends a powerful message: "We are in this together."
Conclusion
A resilient roster is a living document. It breathes with the rhythm of your practice. By using data to predict the peaks, building a flexible employment structure, and leveraging technology like telehealth, you can turn your busiest periods from a nightmare into your most profitable months.
Prepare your roster in peace time, so you don't bleed during the battle.
