Health Minister Aaron Motsoaledi has gazetted draft regulations that would repeal the scope-of-practice rules governing physiotherapists since 1976 and replace them with a 2026 framework. The old regulations described physiotherapy as a field supporting medicine, meaning physios worked on referral from a doctor.

The new ones recognise them as independent, autonomous practitioners who can assess patients, formulate a diagnosis and refer to other health professionals without a doctor's referral. Public comment is open for three months.

The scope widens considerably: The old 1976 rules really limited how physios in SA could operate, namely strictly by instruction/referal from a doctor. But the new rules now make physios able to work independently, make their own diagnoses and create their own treatment plans.

This would fundamentally change how they can operate, creating potential opportunities for SA’s founders building or looking to get into HealthTech, because you now have some 8’354 that can work more independently.

The new regulation adds non-clinical roles: disability assessments, consultancy services and medico-legal reports. But it’s worth noting that it’s a draft, so the 2026 regulations only become the sole statutory standard once finalised, and nothing changes today. And the gazette does not address whether medical schemes will reimburse a direct physiotherapy consultation without a doctor's referral, which is the question that decides how much of this becomes real.

BusinessTech reported the gazetting and published the full list of acts proposed for the profession, from assessment and diagnosis through to pain management and movement optimisation. The draft describes the intent as allowing physiotherapists to undertake comprehensive assessment, order further investigations where necessary, and formulate a diagnosis through clinical reasoning.

Written comments go to the Director-General of Health within three months of publication.

This is a structural change worth noting if you build in health. A practitioner who can only act on a doctor's referral sits downstream of somebody else's system, using whatever the referring practice already runs. A practitioner who is a legitimate first point of contact needs their own stack: patient intake and triage, clinical records that stand up to scrutiny, diagnosis coding, device prescription, outbound referral to other professionals, and medico-legal report generation.

That is a different software buyer with a different budget, and there are thousands of them. The non-clinical additions matter too, because disability assessments and medico-legal reports are document-heavy work of exactly the kind AI is proving useful for as decision support rather than replacement.

Two cautions before anyone builds. The regulations are draft and open for three months of comment, and the reimbursement question is unresolved, so the commercial unlock depends on what medical schemes decide to do rather than on the gazette alone.

You might also like our piece on the first AI-assisted brain tumour operation, Mamor Capital's R300-million first close for post-revenue SA tech, and what South African venture exits actually return.

Get more SA tech and business news and subscribe to The Open Letter.