Can a South African practice charge for a no-show? What the law actually says

Almost every South African practice has had the conversation. Someone does not arrive, the slot is gone, and the room is split: charge them, or let it go?

It turns out this is not a matter of opinion. There is a statute that governs it, professional guidance that narrows it further, and one situation where charging is simply not allowed. Most practices are working off what they think they heard from a colleague.

Here is what the sources actually say.

This is not legal advice. It is a plain-language summary of published sources, written by someone who builds software for practices, not a lawyer. Before you set or enforce a policy, check it with your own attorney or your professional body.

Yes, the law allows it — with conditions

The starting point is section 17 of the Consumer Protection Act 68 of 2008, which covers advance bookings and reservations.

The Act gives a consumer the right to cancel an advance booking for any reason. In exchange, it gives the supplier the right to impose a reasonable cancellation charge. Both halves matter: a patient may cancel whenever they like, and you may charge something for it.

The obvious question is what counts as reasonable. The Act does not give a percentage. It gives a test. A charge is unreasonable if it exceeds a fair amount in the circumstances, having regard to:

• the nature of the service that was booked
• how much notice of cancellation the consumer gave
• the realistic potential for you, acting diligently, to fill the slot with someone else between the cancellation and the appointment
• the general practice of the industry

That third one is the one practices underestimate. If a patient cancels three days out and you could plausibly have filled the slot, a full-consultation charge is hard to defend. If they do not arrive at all and the slot sits empty, your position is considerably stronger.

The National Consumer Commission has also published Explanatory Note 4 of 2023 on reasonable cancellation penalty charges, which is worth reading directly if you are setting a policy.

The exception nobody mentions

Section 17 contains a hard carve-out that gets left out of almost every practice policy.

You may not impose any cancellation fee where the patient could not honour the booking because of death or hospitalisation of the person the booking was made for.

Not a reduced fee. Not at your discretion. None. For a medical practice this is not a remote edge case — it is precisely the population you serve, and it is exactly the kind of missed appointment your reception is most likely to see. Any policy that does not carve this out is wrong on its face, and enforcing it against a family in that situation is the sort of thing that ends up on Facebook.

What the HPCSA adds on top

The CPA is the floor. As a registered practitioner you also sit under professional guidance, and it is narrower.

The clearest published treatment is Appointment cancellations and no shows: To charge or not to charge? by A Barit, in the South African Medical Journal (vol. 109, no. 10, 2019) — also available on SciELO.

As set out there, the HPCSA position permits a practitioner to charge where:

• the cancellation came less than 24 hours before a specialist appointment, or less than 2 hours before a GP appointment
• the practitioner can show they were unable to find another patient for the slot
• the patient was told about the policy when the appointment was booked
• the practitioner has established the reason the patient did not attend or cancel

Read those together and a picture emerges. The right to charge is real, but it is conditional on things you do before the no-show — telling people the policy, keeping a diary you can demonstrate, and asking what happened rather than issuing an invoice.

The last condition is the one that catches practices out. Establishing the reason for non-attendance means picking up the phone and asking. A fee levied without that conversation is difficult to justify if it is ever challenged.

The asymmetry the paper raises

Barit makes an argument worth sitting with, because it is the strongest objection to no-show fees and it does not come from patients.

Patients who miss appointments face a financial penalty. Practitioners who cancel appointments — because theatre ran long, because of an emergency, because of anything — face essentially nothing beyond refunding a prepayment. The paper argues the HPCSA should set guidance requiring practitioners to avoid cancellations except in exceptional circumstances, so that the accountability runs both ways.

You do not have to agree with the conclusion to notice the practical point: a policy your patients experience as one-directional will be resented, and resentment shows up in reviews and in whether people come back. If you charge for late cancellation, it is worth deciding what you do when the cancellation is yours.

Barit's own conclusion is that keeping appointments ultimately rests on good reciprocal communication between the parties. Which brings us to the part practices usually get wrong.

The fee is usually the wrong thing to focus on

Here is the arithmetic that rarely gets done.

Say you charge R400 for a late cancellation. To collect it, reception has to raise it, chase it, and have an awkward conversation with someone who may have had a genuine reason. Some will pay. Some will dispute it. A few will not come back, and one might tell a hundred people why.

Against that: you have recovered R400 on a slot that was probably worth more, and you still had the empty slot.

Now compare it with preventing the no-show. A patient who gets a reminder and can reschedule by replying to it never becomes a no-show — they become a moved appointment, and the original slot is released early enough to offer to someone else. No fee, no confrontation, and the slot earns. This is the whole argument for automated reminders and easy rescheduling: they work on the slot, not on the patient's wallet.

That is why the practices that handle this best tend to have a policy they rarely enforce. The policy exists so it can be mentioned at booking, which is where most of the behavioural effect happens anyway. The revenue comes from attendance, not from penalties.

What to actually do

If you want a defensible policy:

1. Decide the charge and the window, within what the guidance allows — under 24 hours for a specialist, under 2 hours for a GP.
2. Tell every patient at booking. Verbally, on the confirmation, on the booking form. This is a condition, not a nicety.
3. Keep a diary you can point to, so you can show whether the slot could realistically have been filled.
4. Carve out death and hospitalisation explicitly. The law does; your policy should say so.
5. Phone before you invoice. Establishing the reason is required, and half the time it dissolves the issue anyway. That call is also the one your front desk is least likely to find time for — which is worth weighing when you look at what a front desk actually costs to staff.
6. Spend more effort on reminders than on collection. Prevention is worth more than the fee and costs you nothing in goodwill.

And check it with your own attorney. The sources here are public and current as at publication, but a policy touching fees and professional conduct is worth twenty minutes of proper advice.

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Sources: Consumer Protection Act 68 of 2008, section 17; National Consumer Commission, Explanatory Note 4 of 2023; A Barit, "Appointment cancellations and no shows: To charge or not to charge?", South African Medical Journal 109(10), 2019 (UP repository · SciELO). Professional guidance changes — confirm the current position with the HPCSA directly before relying on it.