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Telehealth Good Practice

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Medical Ethics

 

Telehealth Ethical Guidelines (HPCSA)

These ethical guidelines for healthcare practitioners in South Africa regarding the practice of telehealth, emphasising professional conduct, patient care, and the use of technology in healthcare delivery.

The Spirit of Professional Guidelines

The HPCSA emphasizes the importance of trust and ethical practice in healthcare.

  • Good clinical practice is rooted in a trust relationship between patients and healthcare professionals.
  • Practitioners must commit to ethical standards and prioritize patient well-being.
  • These guidelines serve as a framework for evaluating professional conduct.

Definitions of Key Terms

The document defines essential terms related to Telehealth and healthcare practice.

  • Telehealth refers to healthcare services delivered through electronic means across distances.
  • Social media encompasses various online platforms for sharing content.
  • Key roles include “practitioner in charge” and “consulting practitioner,” each with specific responsibilities.

Introduction to Telehealth Guidelines

The HPCSA outlines the purpose and objectives of the Telehealth guidelines.

  • The HPCSA regulates healthcare provision to ensure qualified practitioners deliver services.
  • The term “Telehealth” is preferred over “Telemedicine” for inclusivity.
  • The guidelines aim to improve healthcare access, especially in underserved areas.

Applicability and Use of Telehealth

Telehealth is applicable in various contexts, emphasizing secure communication.

  • Telehealth replicates traditional consultations using secure technology.
  • Practitioners must adhere to principles of patient consent, confidentiality, and record-keeping.
  • Social media is discouraged for patient interactions due to ethical concerns.

Types of Telehealth Services

Different categories of Telehealth services are identified based on their context.

  • Routine Telehealth involves established practitioner-patient relationships and is an adjunct to traditional care.
  • Specialist Telehealth addresses capacity challenges in rural areas, ensuring ethical guidelines are followed.
  • Emergency Telehealth focuses on immediate patient care and stabilization.

Ethical Guidelines for Telehealth Practice

The guidelines provide a framework for ethical Telehealth practices.

  • Practitioners must be registered and competent to provide Telehealth services.
  • The practitioner-patient relationship is established through informed consent.
  • Practitioners are responsible for maintaining detailed records and ensuring quality care.

Considerations for Remote Consultations

Key factors must be evaluated before offering Telehealth consultations.

  • The severity of symptoms and the need for physical examination should be assessed.
  • Previous knowledge of the patient and their medical history is crucial.
  • Social circumstances may necessitate face-to-face consultations.

Evaluation and Treatment Protocols

Protocols for evaluating and treating patients via Telehealth are outlined.

  • A documented medical evaluation is required before treatment.
  • Treatment based solely on online questionnaires is inadequate.
  • Informed consent must be obtained for prescriptions issued through Telehealth.

Professional Duties in Telehealth

Practitioners must uphold their professional duties while engaging in Telehealth.

  • Duties include acting in the patient’s best interest and maintaining confidentiality.
  • Informed consent is mandatory before providing treatment.
  • Verification of practitioner and patient identities is essential.

Informed Consent Requirements

Informed consent is critical for Telehealth practices.

  • Consent can be obtained in writing or recorded orally.
  • Documentation must include patient identities, consent for Telehealth, and security measures.
  • Patients should be informed about who accesses their information and the implications of Telehealth.

Ensuring Patient Confidentiality

Confidentiality must be maintained during Telehealth consultations.

  • Patient confidentiality is protected under various laws and guidelines.
  • Policies for documentation and transmission of records must meet face-to-face standards.
  • Electronic communications must be secure and stored appropriately.

Quality, Security, and Safety of Patient Information

Practitioners are responsible for the quality and security of patient information.

  • Quality assurance measures must be in place for Telehealth services.
  • Patient information should be transmitted securely and only with consent.
  • Safety protocols must prevent accidental loss or alteration of patient data.

Compliance with POPIA Regulations

Practitioners must adhere to the Protection of Personal Information Act (POPIA).

  • Adequate safety measures for patient information processing are required.
  • Compliance with POPIA ensures the protection of personal data in Telehealth practices.

 

Brought to you courtesy of Better Practice Management.

Practice Numbers Info

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đź©ş Why Every South African Doctor Needs a Valid Practice Number

 

 

In South Africa, a practice number isn’t just a formality—it’s your legal gateway to private healthcare billing. Issued by the Board of Healthcare Funders (BHF) via the Practice Code Numbering System (PCNS), this unique identifier confirms your registration with a statutory health council and enables claims processing with medical schemes.

A valid practice number signifies professional legitimacy, regulatory compliance, and eligibility to operate independently. Without it, practitioners cannot legally invoice patients or insurers.

To apply:

  • Register with your relevant council (e.g., HPCSA or AHPCSA)
  • Download and submit the correct PCNS application form
  • Provide supporting documents within 30 days
  • Await BHF accreditation and issuance

đź’° The 2025 annual subscription fee is R472.00, payable to maintain your listing.

✅ To verify any practitioner’s number, visit PCNS Verify.

Stay compliant. Stay credible. Your practice number is your professional passport.

Doctor or Healthcare Provider

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a woman holding a baby in a hospital room

Medicine loses its soul when it becomes mechanical.” > — Dr. Ellapen Rapiti, September 3, 2025

 

✍️

> “Medicine loses its soul when it becomes mechanical.”

> — Dr. Ellapen Rapiti

In today’s clinical landscape, protocols dominate. Algorithms dictate decisions. Time pressures reduce patients to checklists. But healing is not a transaction—it is a relationship. Ethical clinicians must reclaim the heart of medicine by thinking critically, questioning outdated norms, and innovating with dignity.

🔍 What Is Mechanical Medicine?

– Treating symptoms without understanding context

– Following guidelines blindly, even when they conflict with patient needs

– Prioritizing efficiency over empathy

– Ignoring the ethical implications of standardized care

—

🧭 What Does Discerning Practice Look Like?

– Listening deeply, even when time is short

– Asking: “Is this protocol serving the patient—or the system?”

– Advocating for reform when systems fail

– Innovating with compassion, not just compliance

đź’ˇ A Call to Clinicians

You are not just a technician. You are a healer, a thinker, a moral agent. Every time you choose principle over protocol, you restore medicine’s soul. True progress begins with ethical defiance.

> Are you healing—or just complying?

> Principled care begins where blind obedience ends.

To think differently is not defiance, but to apply one’s mind before acting.

All patients are not the same, so treatments must be indivilualised for best outcomes.

—

đź–‹ Authorship & Legacy

This flyer is part of the Ethical Medicine Series by Dr. Ellapen Rapiti.

Growing Healthcare Funding Woes

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Rising Mega Gap Claims Signal Growing Healthcare Funding Woes

The South African private healthcare sector is experiencing a worsening funding crisis, highlighted by a surge in mega gap claims (exceeding R50,000). Between 2020 and 2024, these claims increased by 512% in volume and 437% in value, with the average large loss gap claim reaching R63,000. This escalation is attributed to medical schemes reducing benefits, transferring risk to members, and provider costs outpacing inflation. Specialists’ charges can be over 500% higher than medical scheme reimbursements.

Key Trends and Statistics

  • Increase in Claims: From 2022 to 2024, large loss claims volumes increased by an average of 35% year-on-year.
  • Cost Drivers: Covid-19 and deferred surgeries significantly contributed to a 118% increase in claims value paid in 2021 compared to 2020.
  • Age Distribution: While the highest claims (over R200,000) were for ischaemic heart disease in the 50+ age group, the under-49 age group accounts for 23% of large loss claims.
  • Claim Distribution:
    • 62% of claims fall between R40,000-R60,000
    • 30% fall between R61,000-R100,000
    • 6% fall between R101,000-R150,000
    • 2% fall between R151,000-R210,000* Condition Types: Musculoskeletal conditions account for over 51% of claims, with spinal stenosis being the most common. Cancer and circulatory conditions each represent 10% of large loss claims.

Challenges and Implications

Gap insurance is facing exploitation, with healthcare providers potentially inflating charges upon learning of gap coverage. This threatens the sustainability of gap insurance and could lead to unaffordable premiums. Despite these issues, gap cover remains vital due to deductibles, co-payments, and reimbursement limits in medical schemes. Addressing unregulated provider pricing, benefit erosion, and gap insurance exploitation is crucial to prevent further deepening of the healthcare funding crisis.

Sources:
https://www.bizcommunity.com/article/rising-mega-gap-claims-signal-growing-healthcare-funding-woes-391118a#more

 

Will AI Replace Healthcare Professionals?

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Healthcare Professions: Where Empathy Meets Expertise

Healthcare isn’t just about diagnostics—it’s about people. AI can analyse bloodwork, but it can’t build trust with a nervous patient. It can summarise symptoms, but it can’t guide someone through grief. That’s where human caregivers shine.

Why It Matters:

The US Bureau of Labor Statistics projects that healthcare and social assistance will add about 2.1 million jobs from 2022–2032, more than any other sector, accounting for 45% of all new jobs.

AI-proof factors:

  • High-touch, interpersonal care
  • Ethical and legal constraints on automation
  • Growing demand from aging populations

New Perspective:

AI is already changing healthcare—from robotic surgery to diagnostic assistants—but that doesn’t make doctors and nurses obsolete. In fact, it makes them more effective. The smartest practitioners of the future won’t ignore AI—they’ll know how to work alongside it. Learn AI tools, but never forget: AI can’t look at a patient and understand what the unspoken, non-quantifiable symptoms and expressions are saying. You can.

 

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PAIA For HealthCare Practices

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PAIA Requirement for Healthcare Practitioners

 

Refer to PAIA Memo 29 May 2025, on the Notice from the Information Regulator(IR) to register and submit a section 83(4) PAIA report before 30 June 2025.

Based on the Information Regulator the requirements are that Healthcare Practices, Sole Proprietor and Incorporated, need to submit the Section 83(4) report before the above date.

The objective of the submissions is to determine whether you are receiving and recording requests for access to information in your practice. The report requires you to also indicate whether the requests for information that were received were responded to within the time frames stipulated in PAIA and whether there were any internal appeals and the outcomes of those appeals.

Please take note of important points:

  • All practices need to complete their registration on the IR portal
  • Healthcare information is categorised in POPIA as special personal information.
  • All practices will need to register or migrate their current registration to the new E-service with the IR (Your practice’s appointed Information Officer will be required to register on the IR portal.)

You will require the following information for this registration, as per the addendum.

  1. Incorporated practices – CIPC registration
  2. Sole Proprietor details
  3. Information Officer (IO) and Deputy Information Officer(DIO) – ID numbers (new requirement)

 

Note that submission of access to information Annual Reports will close on 30 June 2025.

 

Additionally, you will not be able to submit your annual report unless your IO, HPB and DIOs are registered with the Regulator.

 

Do whatsapp us if you need assistance: 082 688 9610, or have us fulfill this mandatory  service for you.

 

READ SUMMARY

 

State of the Healthcare Practitioners Market 2025-06-09

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Why is it that SA health practitioners, right now, a reluctant and reticent to invest in, and embrace, taking steps to grow their practices? What is the root cause. And how can one best rekindle their enthusiasm?

South African health practitioners may be reluctant to invest in and embrace steps to grow their practices due to several root causes:

Economic and Financial Concerns

  • Reimbursement Rates: Many practitioners are concerned about declining reimbursement rates from medical aids and other payers. This can make it difficult to maintain profitability, let alone invest in growth.
  • Cost of Investment: Expanding a practice often requires significant financial investment in equipment, staff, and infrastructure. In an uncertain economic environment, practitioners may be hesitant to take on such costs.

Policy and Regulatory Challenges

  • National Health Insurance (NHI): The implementation of the NHI has been a major concern. Some practitioners are reluctant to work under the NHI due to fears of reduced autonomy, lower remuneration, and increased administrative burdens.
  • Regulatory Complexity: The healthcare sector in South Africa is highly regulated. Navigating these regulations can be complex and time-consuming, which may deter practitioners from making significant changes or investments in their practices.

Market and Competition Factors

  • Market Saturation: In some areas, there may be a high density of healthcare providers, leading to intense competition. Practitioners may feel that there is little room for growth or that the effort required to attract new patients is not worth the potential return.
  • Changing Patient Demands: Patients’ expectations and needs are evolving. Keeping up with these changes, such as incorporating new technologies or offering more comprehensive services, can be challenging and costly.

Professional and Personal Considerations

  • Work-Life Balance: The demands of running a growing practice can be overwhelming, potentially leading to a poor work-life balance. Practitioners may prioritize their personal well-being over practice expansion.
  • Risk Aversion: The uncertainty associated with practice growth, such as potential financial losses or failure to meet growth targets, can make practitioners risk-averse.
To rekindle their enthusiasm for practice growth, the following strategies could be effective:

Financial Support and Incentives

  • Grants and Loans: Providing access to grants or low-interest loans specifically for healthcare practitioners looking to expand their practices can help alleviate financial concerns.
  • Reimbursement Reforms: Advocating for fair and sustainable reimbursement rates from medical aids and government programs can make growth more financially viable.

Education and Training

  • Business Training: Offering workshops or courses on practice management, marketing, and financial planning can equip practitioners with the skills needed to successfully grow their practices.
  • Technology Education: Training on the latest healthcare technologies and how to integrate them into practice can make practitioners more confident in their ability to meet modern patient needs.

Policy and Advocacy

  • Engagement with Policymakers: Encouraging practitioners to engage with policymakers to shape regulations that are more supportive of private practice growth can address some of the regulatory hurdles.
  • NHI Collaboration: Finding ways to collaborate with the NHI that are mutually beneficial, such as through pilot programs or incentive schemes, can help practitioners see the potential advantages of participating in the NHI.

Networking and Support

  • Peer Networks: Creating opportunities for practitioners to network and share experiences can provide support and inspiration. Hearing success stories from peers can help rekindle enthusiasm.
  • Mentorship Programs: Establishing mentorship programs where experienced practitioners can guide and support those looking to grow their practices can be highly beneficial.

Patient-Centric Initiatives

  • Patient Feedback: Encouraging practitioners to actively seek and incorporate patient feedback can help them better meet patient needs and improve patient satisfaction, which can drive practice growth.
  • Community Engagement: Promoting community health initiatives or public health campaigns can increase visibility and build goodwill, potentially attracting new patients.

Pending VAT Hike Action Needed

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Uncertainty about VAT hikes no excuse for inaction

Apr 22, 2025

Despite rumours of a potential reversal on the proposed VAT increase, businesses in South Africa must prepare for an increase from 15% to 15,5%, effective 1 May 2025.

By Shaheed Patel, senior tax consultant at CMS South Africa

With Parliament only set to adopt the final Budget around 6 May, this creates a legal and operational grey area, which businesses cannot ignore.

As such, system updates, from accounting software to point-of-sale systems, should be prioritised to prevent compliance headaches.

Prices are legally deemed to include VAT, so businesses must clearly set out appropriate pricing in all public-facing materials (reserving the right to apply VAT at the applicable rate or providing VAT exclusive pricing to which VAT will be added at the applicable rate).

A key determinant of the applicable VAT rate is the “time of supply”.

Generally speaking, the applicable VAT rate is determined by whichever occurs first – the issuing of an invoice or receipt of payment. If either takes place before 1 May, the 15% rate applies; if it happens on or after 1 May, the 15,5% rate comes into effect.

Different timing rules apply to goods supplied under rental agreements, ongoing service contracts, and other successive supplies. In such cases, the supplies are treated as being successively supplied for successive periods of the agreement and the time of supply depends on when a payment becomes due or is received (or an invoice is issued in respect of other types of successive supplies, such as those in the assembly, construction and manufacturing sectors).

Certain transitional relief is available in respect of goods actually delivered before 1 May 2025, and in respect of services rendered to customers during the period before the rate change takes effect. In such cases, VAT at the 15% rate may apply (despite the time of supply rules determining the supply to be on or after 1 May 2025).

Where the supply commences before and ends on or after 1 May 2025 a fair and reasonable apportionment may be made such that VAT may be levied at the 15% rate and 15,5% rate.

Contracts concluded before 1 May 2025 are generally entitled to recover the additional VAT, unless agreed otherwise.

Businesses should also audit supplier invoices and apply the correct rate in claiming input tax in VAT returns.

 

Shareholders Agreement

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two person handshaking

 

Why a Shareholders Agreement?

 

Nobody thinks of this, but if you are going into a business or partnership with someone, you need to have a comprehensive shareholders agreement in place.

 

The shareholders agreement outlines your rights, responsibilities and actions to take when someone wants to exit, or if someone dies, or if you want to bring on another partner, or raise capital, etc.

 

We’ve seen it before when money gets involved, things can go sideways.

 

Rather secure your rights before anything bad happens!

 

Contact:

Better Practice Management 082 688 9610

 

 

 

 

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