According to a government gazette reported by BusinessTech, the Minister of Health Pakishe Aaron Motsoaledi has formally repealed the 1976 regulations that limited physiotherapists to a doctor-referral model. The change matters most to independent physiotherapy practitioners, owners of private clinics and the patients who rely on them, because it removes a legal barrier that has been in place for five decades.
The 1976 regulations, published under Government Notice No. R2301, defined physiotherapy as a support function to medicine. In plain terms, a physiotherapist could only treat a patient after a doctor had referred them. The new gazette declares those rules void, clearing the way for the draft 2026 regulations to become the sole statutory standard once they are finalised. “Gazetted” means the rules have been officially published in the government gazette, giving them legal effect.
The draft 2026 regulations expand the profession’s scope in several ways. Physiotherapists may now conduct a full assessment of a patient, formulate a diagnosis or hypothesis, and refer patients directly to other health professionals without a doctor’s referral. They can also develop and implement patient-centred intervention plans, monitor progress, and provide self-management advice. The regulations explicitly recognise advanced practices such as manual therapy, wound care, airway clearance and the prescription of prosthetic or orthotic devices. Non-clinical roles, including disability assessments, consultancy services and medico-legal reporting, are also permitted.
For small private physiotherapy businesses, the shift could translate into new revenue streams. Clinics will be able to offer first-point-of-contact assessments, sell orthotic devices and provide consultancy contracts to insurers or employers. The ability to refer patients directly may reduce waiting times and make the service more attractive to patients who previously had to navigate a doctor’s appointment first. However, owners will need to adjust their business models, update billing systems and possibly invest in additional training to meet the broader clinical responsibilities.
The Department of Health has opened a three-month window for written comments or representations. Interested parties must submit their views to the Director-General of Health before the deadline. This public comment period gives professional bodies, clinic owners and consumer groups a chance to shape the final wording of the regulations.
South Africa’s health sector has struggled with a shortage of doctors, especially in rural areas. Allowing physiotherapists to operate independently could ease some pressure on the system by providing an alternative entry point for patients with musculoskeletal, cardiovascular or respiratory conditions. For entrepreneurs in the health-service space, the change creates a clearer path to offering comprehensive rehabilitation services without relying on a referral network.
While the repeal is now official, the 2026 regulations are still a draft. Clinics that act early to align their services with the proposed scope may gain a competitive edge, but they should also monitor the final version for any additional requirements. The next step for the sector is to engage with the consultation process and prepare for a new operating environment that recognises physiotherapists as autonomous health professionals.
Read more about similar regulatory updates in the Retail & Consumer section.
Removing the doctor-referral requirement brings South African physiotherapy regulation closer in line with countries such as the United Kingdom and Australia, where direct access to physiotherapists has been standard practice for years, generally justified on the basis that early, unreferred treatment of musculoskeletal injuries reduces both patient recovery time and downstream costs to the health system. For private practice owners specifically, direct access also removes a structural dependency on referring doctors that has shaped how physiotherapy clinics have historically marketed themselves and built patient pipelines. The Health Professions Council of South Africa’s own scope-of-practice guidance will carry the finalised 2026 regulations once published. For related coverage, see this site’s Regulatory and Policy coverage.
