Starting a private practice in South Africa: a step-by-step guide for counsellors and psychologists

The order matters

Several steps depend on the one before. You can’t get a practice number without HPCSA registration, and you can’t register with medical aids without a practice number. Doing them out of order costs weeks.

1. 1HPCSA registration for independent practice
2. 2BHF practice number
3. 3Professional indemnity insurance
4. 4Business basics: bank account, tax and a place to work
5. 5Fees, consent form and intake form
6. 6Medical aid registration, if you will take medical aid clients
7. 7Booking, billing and record keeping
8. 8A website and a way to be found

Step 1: HPCSA registration

You may only practise independently once you are registered with the HPCSA in the independent practice category for your profession. For psychologists that follows the internship, community service where it applies, and the board exam. For registered counsellors it follows the practicum and the board exam.

Your scope of practice is set by your category, and it shapes everything after this: who you may see, what you may call yourself, and which codes you may bill. Our guides to getting your HPCSA registration number and the scope of practice by category cover the detail.

Step 2: BHF practice number

The practice number identifies you to medical schemes. Apply as soon as your HPCSA certificate arrives, because processing takes a few weeks. See BHF practice number: what it is and how to get one.

Even if you plan a cash-only practice, most clients want an invoice they can submit to their scheme, and that invoice needs a practice number.

Step 3: indemnity insurance

Professional indemnity cover protects you if a client brings a claim or a complaint. Arrange it before you see your first client, and check that the cover matches the work you do, including online sessions if you offer them.

Compare what each insurer covers: legal costs for HPCSA complaints, cover for past work after you stop practising, and the limit of indemnity. Note the renewal date as soon as the policy starts.

Step 4: the business basics

• Structure. Most solo practitioners start as sole proprietors. You are taxed in your own name and need no company registration. Speak to an accountant before choosing anything more complex.
• Bank account. A separate account for the practice makes tax and bookkeeping far simpler.
• Tax. Register as a provisional taxpayer with SARS. Income from a practice has no tax deducted at source, so you pay it yourself twice a year.
• A place to work. Sessional rooms rented by the hour keep costs low while your caseload grows. A home office or an online-only practice costs less still.
• POPIA. You are responsible for the personal information you hold from the first client. Decide where records will be kept before you create any.

Step 5: fees and forms

Decide what you charge before anyone asks. Medical aid tariffs give you a floor to work from, and our guide to what registered counsellors and psychologists charge has the current averages.

Then prepare two documents. The consent form records what the client agrees to. The intake form collects what you need to know. See what a counselling consent form must cover and what to include in an intake form, and write your cancellation policy into the consent form from the start.

Step 6: medical aids

A practice number alone doesn’t mean every scheme will pay you. Registering with the main administrators covers most of the market. Which medical aids to register with first explains which three to start with.

Before you tell clients you accept a scheme, confirm that it recognises your category’s codes on the client’s plan.

Step 7: booking, billing and records

This is where new practices lose the most time. A diary in one app, invoices in a spreadsheet and notes in a folder all work with five clients. At twenty they produce missed invoices and double bookings.

Set these up before you are busy:

• A way for clients to book online and receive their forms
• A way to invoice and claim with the right codes
• A secure place for notes and signed forms
• One dashboard that shows what still needs doing

Step 8: being found

How to start your own counselling practice in South Africa is half the question. The other half is how clients find it. In the first year, most come from three places: other practitioners, GPs and schools who refer to you, and people searching online in your area.

A simple website with your services, fees, registration details and a booking button does most of the work. Keep what you say within the HPCSA’s rules on advertising: accurate, not misleading, and with no promises of results. Our guide to getting referrals covers the colleague side.