A Specialist Family Physician is a medical specialist trained to provide comprehensive, continuous health care for people across all ages, genders, and health conditions.
How is a Specialist Family Physician different from a GP?
A GP (general practitioner) may finish medical school and start practising without postgraduate training. A Specialist Family Physician, by contrast, completes advanced postgraduate training in family medicine, a recognised medical speciality. This training focuses on integrating biological, clinical, and behavioural sciences to understand the whole person in their family and community context.
What role do Specialist Family Physicians play in health care?
Specialist Family Physicians are often described as medical generalists. This means they do not narrow their practice to one organ system or age group. Instead, they:
- Support first contact-care, meaning you can see them when a health issue first arises.
- Provide continuity of care, following you over time, rather than just treating single episodes.
- Coordinate with other specialists, ensuring your care is integrated and not fragmented.
- Address both physical and mental health needs, acknowledging how these often overlap.
- Care for the entire family unit, from children to older adults, is especially important for chronic conditions affecting multiple generations.
Why does this matter in South Africa?
In South Africa, the health landscape is unique. We face high burdens of HIV, TB, diabetes, hypertension, obesity, and other chronic conditions. A Specialist Family Physician is trained to manage the mix of infectious and non-communicable diseases. They are particularly well-suited to complex health needs that affect families as a whole.
Specialist Family Physicians also bring leadership to multidisciplinary teams. For example, Dr Gail Ashford works alongside a clinical psychologist and an occupational therapist at Feeling Positive Physical and Mental Health. Together, they address health through medication and mental health support, rehabilitation, and guidance on navigating everyday challenges.
How does this benefit me?
Seeing a Specialist Family Physician means that your care is:
- Holistic: Your physical, emotional, and social context is part of the conversation.
- Accessible: You have a first point of contact for a wide range of health needs.
- Coordinated: You are guided through the health system, not left to manage alone.
- Supportive: Especially for ongoing conditions like HIV, diabetes, or autoimmune disease, where care must adapt to your everyday life.
It is essential to note that Dr Gail’s consultations are thorough, encompassing multiple health domains. As a result, and as her Speciality is not recognised correctly by many Medical Aids, Gail’s fees are charged upfront. You are requested to submit your claim to your medical aid to obtain partial reimbursement (this will depend on your medical aid; for example, Discovery, Camaf, and ProfMed offer much better reimbursement than other medical aids).
What are we doing about the Undermining and Unconstitutional refusal by Medical Aids to remunerate Specialist Family Physicians?
Gail is an executive member of the Specialist Family Physicians in Private (SFPP) subgroup of the South African Academy of Family Physicians (SAAFP) and is actively involved in advocating for recognition and appropriate remuneration of this speciality.
Family Medicine is a Speciality registered and authorised by the College of Medicine South Africa (CMSA) and Health Professions Council of South Africa (HPCSA).
Specialist Family Physicians complete a four-year post-graduate training that covers 10 different domains and is duly recognised as a speciality, just like being a Surgeon, Physician, ENT or Gynaecologist. SFPs are qualified specialists who provide professional services as expert generalists, having completed postgraduate training in Family Medicine.
In a legal opinion obtained by Klinck and Samuels, it is unconstitutional and a gross injustice that medical aids and health funders are wilfully ignoring and undermining this recognised speciality.
“Pertinent comments from the legal opinion obtained in July 2025:
- Despite this recognition by the HPCSA, most SFPs working in the private sector: are compelled to work as general practitioners (GPs) and cannot order investigations, imaging and medications appropriate to their specialist training;
- are reimbursed according to medical scheme tariffs for GPs and not as specialists;
- are denied hospital admission rights, limiting their ability to function as specialists in private practice hospital settings, as well as by some private hospital groups and funders.1
Any discrimination of SFPs in terms of Specialist registration, recognition, and remuneration would contravene the HPCSA ethical rules.
13 HPCSA Booklet 19: “Guidelines for Health Practitioners on matters relating to ethical billing practices”, 14 S 35 read with Regulation 2 of the HPA and Sections 9,15, 1016 and 2217 of the Constitution of the Republic of South Africa (“Constitution”).
CONCLUSION
26. In essence, SFPs, as registered specialists in private practice, are uniquely equipped to provide a diverse range of skilled services at multiple levels of care.”
20. The differences in scope and competencies between an SFP, Physician and General Practitioner are set out in two tables below:
| SFP | Physician | GP | |
|---|---|---|---|
| Post-graduate fellowship qualification | Yes | Yes | No |
| Scope of practice | Internal medicine, Paediatrics, O&G, ENT, Surgery, Dermatology, Psychiatry, Orthopaedics, Paliative care, Anaesthetics, Emergency medicine | Internal Medicine | Undergraduate clinical training programme |
| Consultation style | Brief motivational interviewing, Bio-psycho-social approach, counselling skills, behaviour change, Staff’s consultation model | Unknown | Introduction to consultation skills during undergraduate rotation through Family Medicine department. |
| Patient population | All ages and genders | Adults only | All ages and genders |
| Undifferentiated patients | Yes | No | Yes |
| Consultation length | Extended and comprehensive | Extended, but focused on presenting complaint and affected organ. | Brief and focused to presenting complaint. |
| Psychotherapy | Yes, structured training in psychotherapy and mental health management | No | No |
| SFP | Physician | GP | |
|---|---|---|---|
| Skill set | Structured training at postgraduate level internal medicine, paediatrics, anaesthetics, surgery, psychiatry, O&G, paliative care. | Structured training in internal medicine for adults only | Undergraduate training only |
| Continuity of care | Yes, for the whole family with reduced referrals to other specialists | Limited, only for internal medicine related problems in adults. Need for referral to other specialists for any other co-existing pathologies. | Yes, for the whole family but limited in scope of practice and needing routine up-referrals to subject specialists. |
| Complex patient management | Yes, routine management of patients with multiple comorbidlities across different disciplines with minimal refferals to other specialists. | Yes, management of adults with multiple co-morbidilites within the scope of internal medicine practice. | Yes, routine management with high referral rates to subject specialists |
| Out of hospital care | Yes, can practice from outpatient rooms, day clinics, hospital at home, day theatre settings. Reduced hospital admissions, other specialists referrals and casualty visits results in lower healthcare costs | Mainly hospital-based patient care and critical care management | Yes, almost exclusively outpatient rooms based |
In short
A Specialist Family Physician is your medical partner across the life course. Someone who can address a sore throat today, help manage diabetes tomorrow, and guide your family through pregnancy, HIV care, or ageing. Their role is about walking with you through the long journey of health, ensuring that your care is inclusive, sensitive, and anchored in real-world South African experience.
Contact us for more information.