Summary of Amendments to the HPCSA Ethical Rules of Conduct (Board Notice 510 of 2023)
- Martin Viljoen
- Aug 22
- 3 min read
On 17 November 2023, the Registrar of the Health Professions Council of South Africa (“HPCSA”) published certain amendments to the Ethical Rules for the Conduct of Practitioners Registered under the Health Professions Act, 1974 (GNR 717, dated 4 August 2006) (“the Ethical Rules”).
The amendments are entitled “Proposed Amendments to the Ethical Rules of Conduct for Practitioners Registered under the Health Professions Act, 1974” and were published in Board Notice 510 in GG 49720 (“the Amendment Notice”). Although the title of the Amendment Notice refers to “Proposed Amendments”, the Registrar of the HPCSA has since confirmed that the amendments are indeed final.
The Amendment Notice has the effect of fundamentally changing the landscape in which healthcare “practitioners”, as that term is defined in the Ethical Rules, may collaborate with others. We deal below with certain of the key changes.
Multidisciplinary Practices (MDPs)
Practitioners from different health professions may now form multidisciplinary practices.
Previously discouraged, this is now explicitly permitted, provided patients’ interests remain central.
Encourages collaboration across professions (e.g., doctors, physiotherapists, psychologists under one roof).
Compliance Requirement:
Ensure written agreements are in place detailing responsibilities, cost-sharing, and governance.
Maintain clear records that patient interests come first.
Do not use MDPs as referral-for-profit schemes
Fee Sharing & Business Arrangements
Practitioners may now enter into fee-sharing agreements and business partnerships with other registered practitioners.
This must be transparent, documented, and not exploitative.
The intent is to facilitate group practices and multidisciplinary centres, rather than forcing practitioners to work in isolation.
Compliance Requirement:
Ensure formal contracts cover fee-sharing arrangements.
Patients must not be charged extra because of these agreements.
Keep documentation for audit purposes.
Premises & Facility Sharing
Practitioners may share premises, staff, and administrative resources across different disciplines.
Rental and cost-sharing arrangements are allowed if they are fair, market-related, and do not compromise patient care.
Compliance Requirement:
All agreements must be in writing and at arm’s length (fair market value).
Ensure patient privacy and record confidentiality in shared spaces.
Employment of Practitioners
A registered practitioner may now employ another registered practitioner (within defined limits).
This allows larger practices, private hospitals, and multidisciplinary clinics to employ health professionals legitimately.
Protects junior practitioners from exploitative conditions through ethical safeguards.
Compliance Requirement:
Draft contracts of employment that protect professional independence.
Employment terms must be fair, lawful, and transparent.
HPCSA can investigate exploitative arrangements.
Disclosure of Interests in Hospitals or Facilities
Practitioners must disclose any financial or ownership interest they hold in a private hospital, day clinic, or medical facility.
This aims to avoid conflicts of interest in patient referrals and service use.
Compliance Requirement:
Declare all such interests to the HPCSA and to patients when relevant.
Keep records of disclosures and referral justification.
Contractual Relationships
Practitioners may contract with hospitals, clinics, medical schemes, and other practitioners, as long as such contracts:
Do not interfere with clinical independence.
Are fair, transparent, and lawful.
Previously, some restrictive interpretations limited these arrangements.
Compliance Requirement:
Ensure contracts include clauses preserving clinical decision-making autonomy.
Avoid contracts that incentivise unnecessary treatments or referrals.
Professional Autonomy and Patient Protection
Even within partnerships, MDPs, or employment, practitioners must always retain clinical independence.
Any arrangement that prioritises profit over patient welfare remains unethical.
Compliance Requirement:
Continue regular patient-centred ethical practice.
Document decision-making, referrals, and financial arrangements.
Practical Implications for Practitioners
✅ Easier to establish group practices and multidisciplinary rehabilitation or wellness centres.
✅ Legitimises employment and contracting models in private practice.
✅ Allows more cost-efficient resource sharing (premises, staff, equipment).
✅ Greater flexibility to adapt to modern healthcare delivery models.
❌ Still prohibited: arrangements that exploit patients, compromise independence of judgment, or amount to kickbacks/referral fees.
📌 In essence: These amendments mark a progressive shift away from rigid solo-practice restrictions, encouraging collaboration, integration, and efficiency — while keeping strong safeguards for patient safety, autonomy, and ethical practice.
Click on the link below to view the released gazette on 17 November 2023:
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