Amendments to the Health Professions Council of South Africa Ethical Rules of Conduct published on 17 November 2023 in Government Gazette No. 49720 are likely to have a significant impact on the practice of medicine in South Africa.

The amendments are available from the South African Government website here.

While this is not intended to be a complete analysis, we believe the following changes to be of particular importance:

Introduction of new concepts

The amended Ethical Rules of Conduct contemplate the following new concepts:

• ‘Multidisciplinary healthcare’ meaning ‘healthcare delivery that involves multiple health practitioners from different professions of healthcare. The health practitioners often work as a team to provide wholesome healthcare services for the benefit of the patient’.
• ‘Quality healthcare services’ meaning the delivery of health care that is effective, safe and people centred, aimed at achieving desirable outcomes using evidence-based healthcare services to all who could benefit.
• ‘Appropriate healthcare’ meaning healthcare delivery which is expected to deliver clinical benefits of care that outweigh the expected negative effects to such an extent that the treatment is justified.
• ‘Collaborative practices’ meaning the practices that occurs when multiple health practitioners, from different professional backgrounds, work together with patients, families, carers and communities to deliver the highest quality of care across settings.

Fees and commissions

Ethical Rule 7 dealing with Fees and Commissions provides at sub-rules (4) and (5) that:

‘(4) A practitioner shall not share fees with any person or with another practitioner who has not taken a commensurate part in the services for which such fees are charged.

(5) A practitioner shall not charge or receive fees for services not personally rendered, except for services rendered by another practitioner in his or her employment or with whom he or she is associated as a partner, shareholder or locum tenens.’

To this, the following has been added:

‘(6) Notwithstanding anything contained in sub-rules (4) and (5) above, a practitioner may share, charge or receive fees from another practitioner: Provided that in such an instance, there is an express agreement, arrangement or model of rendering multi-disciplinary based health-care services to patients which is structured, which provides high quality health-care services or products, contain costs of rendering health-care services, and enhance access to appropriate healthcare’ (our emphasis).

Partnerships

Ethical Rule 8 dealing with Partnership and Juristic Persons originally prohibited practitioners of different specialities from practising in partnership, association or as a juristic person.  This prohibition has been watered down by the addition of the following Sub-Rule:

‘(5) Notwithstanding anything contained in this rule, a practitioner may provide health-care services with other registered practitioners, persons registered in terms of the Act, or in terms of any other legislation regulating  health professions: Provided that the primary aim will be to enhance the quality of health-care services to patients, and further that there is an express agreement, arrangement or model of rendering multi-disciplinary based  health-care services to patients which provides high quality health-care services or products to patients, structured to contain costs, and enhance access to appropriate healthcare.’ (our emphasis)

Employment contracts

In terms of employment contracts, dealt with at Rule 18, it is now required that ‘the Practitioner ensure that: the employment contract has as its primary aim the enhancement of the quality of health-care services to patients, is structured to contain costs, enhance access  to appropriate, high quality health-care services or products to patients, and is  not designed to extract profit for the benefit of the practitioner or their employer to the detriment of patients’.

Conclusion

These amendments cover a range of issues of importance to the practice of medicine in South Africa and introduce significant changes.

For healthcare practitioners, the new rules open up new ways of working and the opportunity to offer patients a more comprehensive medical service.

It remains to be seen whether these changes will be followed up with reforms to the relatively conservative business practices guidelines and the guidelines dealing with the employment of practitioners as these guidelines do not naturally accommodate the concept of multi-disciplinary or collaborative practices.

Indemnity organisations and insurers will need to consider how they will insure these multi-disciplinary or collaborative practices as they open up potential new and increased medico-legal risks.