Locums vs Employees in a Medical Practice: What Every Practice Owner Should Know
Locums vs Employees in a Medical Practice: What Every Practice Owner Should Know


In the ever-evolving world of private healthcare in South Africa, medical professionals often face a key operational decision: Should I hire full-time employees or bring in locums on a contract basis?
While hiring locums offers flexibility and short-term cost savings, there are important tax, legal, and compliance considerations that every practice owner should understand. Missteps can result in penalties, back taxes, or even damage to your reputation. Let’s explore the core differences between locums and employees, and how each is treated under South African income tax law, PAYE, and labour regulations like COIDA.
1. The Legal Distinction: Employee vs Independent Contractor (Locum)
The core difference lies in control and independence:
- Employees: Work under the control and supervision of the employer. They typically have fixed hours, use your equipment, and are subject to internal HR policies.
- Locums (Independent Contractors): Provide services on a temporary or part-time basis, usually using their own tools, and often have control over how and when the work is performed.
But just calling someone a “locum” doesn’t make them one. SARS and the Department of Labour apply substance-over-form principles.
2. HPCSA Guidelines on Locums
According to the HPCSA:
- You may only hire HPCSA-registered practitioners in good standing as locums.
- Even when a locum is working, you remain legally and ethically responsible for everything that happens in your practice.
- A formal locum agreement is recommended, outlining the scope of work, confidentiality, and billing arrangements.
- Locums may not be presented as the practice owner or advertise the practice as their own.
- If billing is done under your name or practice number, you must retain control of billing, and the locum must be paid a fixed fee, not a revenue share.
Practice Owner Liability: If anything goes wrong, the HPCSA holds the practice owner accountable, whether or not you were physically present
3. Income Tax and PAYE Obligations
For Employees
- Employers must register for PAYE and withhold taxes on behalf of the employee each month.
- UIF and potentially SDL (Skills Development Levy) also apply.
- Employees receive an IRP5 annually.
For Locums (Independent Contractors)
- If the locum is truly independent, they are responsible for their own income tax, provisional tax filings, and VAT (if over the R1 million threshold).
- However, SARS may deem the locum to be an employee for PAYE purposes if:
- They render services mainly at your premises.
- They’re subject to your control or supervision.
If so, you must withhold PAYE, even if there’s no employment contract. Failure to do so can result in backdated tax liabilities and penalties.
4. COIDA – Compensation for Occupational Injuries and Diseases
Employees:
- You are legally required to register them under COIDA.
- Must submit annual returns and pay the necessary levies.
Locums:
- If they are truly independent, they are not your responsibility under COIDA.
- However, misclassification could result in penalties and unpaid COIDA assessments.
5. UIF and Labour Law
- Employees: Must be registered for UIF; they’re also protected under the Basic Conditions of Employment Act (leave, working hours, etc.).
- Locums: Generally not entitled to UIF or labour protections—but again, only if they’re genuinely independent.
6. Benefits of Hiring Locums
Flexibility: Bring in skills as needed, without the long-term commitment. Cost-Efficiency: No UIF, COIDA, or leave benefits required – if appropriately structured. Specialisation: Access niche skills for specific procedures or patient loads. Best Practice Tips
- Have a signed independent contractor agreement that outlines the scope, payment, and independence.
- Avoid giving locums regular hours and responsibilities that are identical to those of employees.
- Verify tax and VAT compliance—including whether PAYE needs to be withheld.
- Ensure separate professional indemnity cover is in place.
- Seek a tax or legal opinion when in doubt, especially for long-term or recurring locums.
Conclusion
Hiring locums can be a smart move for growing or lean practices—but only if you get the structure right. In South Africa, the tax and legal implications are nuanced, and the cost of non-compliance can outweigh the savings. If you’re unsure about your current locum arrangements or need help ensuring tax and legal compliance, we’re here to help. At GAS Accounting, we specialise in assisting medical professionals to build profitable, compliant, and sustainable practices