The Central City District will play an important role in achieving the goals within the over arching Greater Sydney Region Plan to support population and economic growth in the coming decades. Greater Parramatta and more specifically Parramatta CBD will be the focal hub for the district to generate employment opportunities leading to rising population and greater housing demand.
Our philosophy focuses on using research to help make well informed business and property decisions that can be implemented today and safeguard for the future. The HPS Outlook newsletter will initially concentrate on New South Wales with insight on growth corridors, population projections, demographics, local and state government initiatives and major infrastructure projects.
Doctors shoulder a huge responsibility as a stoic pillar of society, working long hours to care for their patients. Behind the scenes though, doctors are more often overwhelmed, drowning in paperwork and struggling to meet increased regulatory requirements.
The Australian Medical Association (AMA) has recently reported the results of a survey conducted by the Canadian Medical Association (CMA) that reveals over fifty percent of doctors have symptoms of stress and burnout. What’s more alarming is that many physicians themselves don’t like to talk about it given the infallible perception doctors have in the community.
As an Australian General Practitioner, how can you diagnose yourself when the signs of burnout begin to appear? And, how can you get help addressing the underlying causes?
GPs will often diagnose burnout in their patients but may turn a blind eye to their own symptoms of stress and burnout. Burnout is simply a state of exhaustion caused by a period of prolonged stress. Symptoms may appear subtle at first but will increase in severity over time.
1. Physical; Feeling tired and drained most of the time.
2. Behavioural; An increasing need to isolate yourself from others and your responsibilities.
3. Emotional; A feeling of being helpless, trapped and defeated.
With administrative tasks and regulatory requirements cited as the main cause of prolonged stress, many GPs are choosing to outsource key functions or get consultative help to reduce the burden. Typically, this looks at systems and process to increase operational efficiency, identifying and managing risks to reduce nasty surprises and putting plans in place to achieve the required regulatory compliance.
By getting help with the administrative aspects, the GP can focus on the needs of patients in the clinic with the peace of mind there is no paperwork building up back at the office.
Doctors are human. To reduce the inevitable stress involved in managing a health practice a GP may wish to consider what areas are causing prolonged stress and re-engineer or outsource this aspect of the practice before a more sinister sense of burnout begins.
Talk to an experienced consultant on strategies for setting up your healthcare business for stress-free success as part of our Clinical Business Consultation Services.
Every business needs a strategic and targeted marketing and advertising plan to get their brand noticed by customers. The medical and wider healthcare industries are no different, but they come up against unique challenges when implementing their advertising as they have to comply with additional strict laws and guidelines in Australia.
The Australian Health Practitioner Regulation Agency (APHRA) states “Supporting the public to make informed healthcare choices with the right information at the right time is extremely important and advertising can heavily influence a patient’s decision-making around their healthcare needs.”
So, it’s essential for your business, as well as the health of your patients that your advertising is compliant.
“Section 133 of the National Law relates to advertising. It states that: (1) A person must not advertise a regulated health service, or a business that provides a regulated health service, in a way that—
(a) is false, misleading or deceptive or is likely to be misleading or deceptive; or
(b) offers a gift, discount or other inducement to attract a person to use the service or the business, unless the advertisement also states the terms and conditions of the offer; or
(c) uses testimonials or purported testimonials about the service or business; or
(d) creates an unreasonable expectation of beneficial treatment; or
(e) directly or indirectly encourages the indiscriminate or unnecessary use of regulated health services.”
Source: http://www.ahpra.gov.au/Publications/Advertising-resources/Legislation-guidelines.aspx
Some practitioners shy away from promoting their services, for fear of retribution if they get it wrong. While caution is extremely important, the rules exist to not only protect the public, but to also to help guide practitioners.
Even when you engage someone else to create your advertising content, the onus is still on you as the Doctor/Health Professional/Business Owner to ensure this content is compliant. So, while every effort will be made by a competent and experienced health and medical writer or marketer, final signoff before publication really has to come from you. It is your business and reputation on the line.
AHPRA states: “registered health practitioner, or a business providing a regulated health service, whose advertising breaches the National Law, may be liable for a $5,000 penalty (for an individual) or $10,000 (for a body corporate).”
Here, we’re reminded of the 2015 case of Dr Blog when he engaged the services of a Marketing Agency to revamp his website and increase his brand’s reach across Social Media. Not being familiar with the National Law or AHPRA Guidelines, the agency set about implementing their branding strategy and erroneously included testimonials on Dr Blog’s Social Media Platforms. As it was Dr Blog’s ultimate responsibility to ensure his advertising content was lawful, it was his business that took the fall for this breach, not the Marketing Agency.
Although you can’t control what patients say on social media channels of their own,
you must not share or promote testimonials on your own pages.
How you promote your business or project is vital to its success. Our Communications and Marketing Unit works with you to promote your project to relevant stakeholders. We develop effective Communications strategies that include the creation of marketing collateral for cross promotional use in digital and traditional media.
Contact us today to see how we can help you reach your audience effectively and compliantly.
A development application for a state-of-the-art specialist centre and private hospital has been lodged this week with Clarence Valley Council.
The D.A details plans for a multi-level, purpose-built, healthcare centre to be located at Arthur and Queen Streets, Grafton.
The centre will provide access to high-tech infrastructure for the specialist care and services in the Clarence Valley residents.
The plans are the brainchild of local doctor and orthopaedic surgeon Dr Sam Martin, who performed the first total joint replacement surgery in Grafton Base Hospital five years ago.
When the surgeon shared his idea on social media late last year the community responded within minutes. The post attracted as many as nine hundred replies or likes for the clinician’s vision for Grafton’s healthcare future. Dr Martin said:
“Now, many Clarence Valley residents travel long distances for specialist services. This can mean long times away from their home, family members and friends.
“In my specialist field for example residents of Grafton and surrounding areas have previously had to travel to Coffs Harbour or Lismore for joint replacement surgery.
“The alternative can be lengthy wait times for treatment in the already over burden public hospital system.” Dr Martin said.
The specialist at Grafton Base Hospital believes the project will create jobs and help attract the necessary practitioners to the area such as cardiologists, urologists, gastroenterologists, obstetricians and psychiatrists.
“The planned specialist centre which will be adjacent to the public hospital would support community healthcare professionals from various specialities to work collaboratively and make healthcare and wellbeing services more streamlined for Grafton,” he said.
Dr Allan Tyson, director of Anaesthetics and chair of the medical staff council at Grafton Base Hospital welcomed news of the DA. The advocate for better health services in the Clarence Valley said:
“While things have been improving in the region, new health infrastructure would certainly help attract further specialist services to Grafton. Further investment in healthcare infrastructure is prudent particularly with the current predicted population growth for the town.”
MEDIA CONTACT: Victoria Hollick M 0418 802 000 E victoria.h@healthprojectservices.com.au
These are some of the key tax requirements to consider when owning or leasing property for your Medical practice:
These are some of the major tax implications to consider:
Whether you own or are considering purchasing a property for the purpose of establishing your medical practice, it is important to consider any tax implications and minimise your tax exposure. The Australian taxation system can be complicated, and we suggest seeking professional advice about your property.
Steven Wilkie, Director at Bongiorno & Partners, advises that owners of premises should consider the following factors:
1. Structure of ownership of the property
2. Finance
Most of the banks lend less on a commercial property, that is, a lower loan to valuation ratio (LVR), thus requiring a greater deposit, sometimes higher interest rates may also apply. There are a few banks that feel comfortable lending to Medical Professionals and therefore have fewer restrictions than others.
3. Capital Gains Tax implications of the structure
4. Holding costs, including depreciation
5. Income tax implications
Steven Wilkie (B.Econ.(Accounting), CA, CTA) is a Director at Bongiorno & Partners. Bongiorno has access to specialised accounting and taxation facilities exclusively for medical and dental practitioners. Bongiorno prepare all Tax Returns and BAS for their clients. Bongiorno provide advice on tax issues for all investments, borrowing or business matters.
As this general advice has been prepared without taking account of your objectives, financial situation or needs, you should consider the appropriateness of this advice before acting on it.
Healthcare property continues to outperform all other property sectors and offers a lower risk investment.
Key points:
The Australian property market is continuing to evolve, with specialised market sectors emerging and performing above traditional property assets, this has been evident with the Healthcare property sector. In particular the last five years, where main stream property assets such as office and retail have struggled with the impact of the GFC, which resulted in highly volatile returns.
According to a recent report The Property Council/IPD Australia Quarterly Healthcare Property Index published by the Property Council of Australia and IPD Australia & New Zealand, over the last five years on an annualised basis total returns for healthcare properties was 10.7% well above the all property total return of 7.2%. This result can be contributed to the secure rental return of healthcare properties due to the strong long term tenant profile of healthcare professionals.
Total return for All Property and Healthcare annualised returns to December 2013
Healthcare tenants are also driven by different market forces compared to commercial and retail tenants who are more vulnerable to economic fluctuations. This market is predominately driven by population growth, demand is further compounded by the increase in an ageing population which have a higher dependency on medical services.
| Australian male population projections by age group 2012 v 2031 | Australian female population projections by age group 2012 v 2031 |
Over the next 20 years the Australian Bureau of Statistics (ABS) projects Australia’s population based on medium growth assumptions for fertility rate, mortality rate and net overseas migration to grow by around one third or 1.69% per annum on average. In the age groups over 75 years the average annual growth rate is noticeably higher of 4% to 5%, this will see greater demand for healthcare services.
As the population continues to grow and people continue to sprawl out beyond metropolitan areas, there are opportunities in regional areas that should be considered, especially for professionals who are seeking a lifestyle change from urban centres.
Over recent years we have seen enquiries increase for Purpose Built Facilities, Specialist Centres and Mixed Use Medical Centres as medical professionals are becoming more sophisticated property investors. Looking at the smaller end of the market such as healthcare practices operating from retail strip shops, commercial offices and shopping centres, offer an affordable entry point for investors. In Sydney, a small investor can purchase a typical commercial strata suite for sub $500,000; while larger investors can acquire commercial buildings or prime retail strip shops from $1.50 million up to $2.50 million for space in well-established suburban areas.
In the current low interest rate market coupled with greater availability of finance and competitive property yields, there are opportunities for Owner Occupiers to expand their practice through property. Any excess space can leased to other complementary/referral businesses that will assist business growth and provide additional business revenue. By purchasing your own property, you have greater control and security, as it is not uncommon for tenants to be forced to relocate after many years which can be detrimental to your business when you have an established clientele and referral network.
In this market segment, we have also seen a greater number of purchasers funding their investment through their own Self-Managed Super Fund to build their retirement strategy around the business property.
In conclusion, healthcare properties offer an affordable, lower risk profile as tenants are less sensitive to current economic market fluctuations domestically and internationally, combined with a long lease with a stable income stream and tax benefits to provide a good return. Looking ahead, there will be higher demand for healthcare services due to Australia’s project population growth, particularly from older age groups whom have a greater dependency on health services.
Get a successful outcome from your property choices with the RIGHT RESEARCH
Making an early start on research before you go ahead with a property lease or purchase saves time and money, now and in the future.
When it is time to make a significant investment in a property for your healthcare business, making the right decision relies on having current and accurate information about your chosen location.
“Research is the first step to a successful deal,” says Health Project Services CEO Dean Crozier. “Market conditions are constantly changing and through good research you can identify both risks and opportunities to ensure you are making wise choices for strong business outcomes and investment returns.”
Sector specific research is just one of the dedicated property and business consulting services Health Project Services (HPS) offer to the healthcare sector. As well as helping you find a suitable property in the right location, research can save you time, money and reduce your risk in a whole range of ways as you work towards establishing and growing your new business.
Negotiating your lease or purchase: having access to current information about the local property market puts you in a much stronger position when it comes to negotiating a property lease or acquisition.
Applying for funding: accurate, researched demographic data and competition analysis, provides confidence when applying for government and external grants.
Business planning and arranging finance: in depth and targeted research that has been specifically applied to your business will provide you with accurate information to develop your business model. It will also support your business case when seeking finance or investment for your property and business.
Marketing your business: by looking at critical factors that influence your local market, good research can help you understand how best to communicate with potential clients.
Investing in professional research will save you time, money and a lot of stress and reduce financial risk. The HPS research team can access the right information, quickly and effectively and deliver a tailored report in a simple format with all the data you need to enable you to make well-informed financial decisions.
Location: choosing the right location for a new healthcare premises depends on a whole range of factors. At HPS, our location research and analysis can target multiple suburbs and summarise the relative benefits and opportunities of each one.
Competition Analysis: our research will identify and report on any healthcare facilities in your target locations that could affect demand for your new business and services.
Planning: by sharing our detailed knowledge of planning laws and development approval processes throughout Australia, we can limit your risks so you can choose a property and be certain that it complies with planning requirements for the healthcare sector.
Property Market Overview: a detailed report on local property markets – including property values, occupancy, rental rates and type of properties available – gives you the information you need to find suitable properties in your target area and negotiate a fair lease arrangement or purchase price.
Demographics: to learn about your potential customers and the types of services they need, you will be looking for key statistics about local demographics including age, income, employment and future population growth.
Health Project Services can support your healthcare business goals with our practical, current and detailed research findings.
© 2016 Health Project Services. All Rights Reserved
A simple guide to key rules and regulations you should be aware of relating to a medical property. The five most common issues are:
Before signing a contract for sale or commencing works on a new refurbishment/fit out or expansion project for a medical property, it is critical to consider any modifications that may need to be done to make the property compliant with current building codes and regulations.
There are specific requirements that apply to properties being used for medical purposes that do not apply to other uses such as shops or offices. Some of the more common issues can be minimised or even avoided if consideration is given to the following five points when viewing a potential property.
The local Council will have specific rules pertaining to parking at the property, including the minimum number of parking spaces that need to be provided for both staff and patients. Every Council is different and their requirements can be found in their Development Control Plan (DCP) available on the Council website.
The number of spaces the Council require you to provide will be based on either the size of the property or quantity of healthcare consulting rooms. Typically most Councils also require there to be a dedicated Disabled parking space and sometimes also an Ambulance Bay. Another important consideration is the ability to drive in and out of the car park in a forward motion so that vehicles are not backing out onto main roads.
Failing to comply with the Council’s minimum requirements for car parking could either result in the Development Application for the medical practice being rejected, or an additional levy payment to Council (called a “Section 94”) being imposed.
So before you begin to look at the inside of the property, take a look outside first. Knowing whether you can provide parking that is compliant with Council’s requirements can save you from spending time on properties that are unlikely to get planning approval as a medical practice.
Under the Disability Discrimination Act 1992 (DDA) access into the property should be equitable for both people who are able bodied and those with disabilities. For a medical premises, this means that giving disabled patients an alternative more cumbersome pathway into the property ‘around the back’ is not acceptable. When looking at a property consider whether the current entrance enables wheelchair access or does it require modification? If so, the cost to add an external entry ramp needs to be factored into your budget, these typically cost between $5,000 and $10,000.
The Disability (Access to Premises – Buildings) Standards 2010 applies to an owner-occupier or tenant who leases the whole building for a healthcare facility to ensure all patients have equal access inside the premises. In your first inspection of a property make a note of whether the floor is one level, or does the space flow over several levels or have multiple storeys? If the property is not ‘step-free’ you may need to build internal ramps or install a lift. Both options can take up valuable space intended for consulting rooms and add significant expense to the budget. Generally a lift can cost upwards of $100,000, while ramps tend to be around $5,000 to $15,000.
Also, consideration needs to be given to the layout of the property. If doorways and corridors are too narrow to enable a wheelchair to enter or turn sufficiently then the layout may need to be modified. This is a common issue with older style properties and particularly former residential houses that have been converted to commercial use, as they were built under less stringent regulations.
The Building Code of Australia (BCA) sets out minimum requirements for new construction and refurbishment of buildings, including the quantity, type and size of toilets that need to be provided for patients and staff. The requirements are based on the type of business, number of consulting rooms, number of staff and expected number of patients.
It is now mandatory to provide accessible toilets so when viewing a property don’t forget to also look at what facilities are currently provided. If a disabled toilet needs to be added, the cost can be around $30,000 to $40,000. There are two types of accessible toilets required:
Ambulant Toilet: This a toilet cubicle usually located at the end of the row with a door that swings outwards, width of 900 mm to 920 mm, special dimension toilet pan and handrails provided on each wall.
Disabled Toilet: There is a minimum size requirement of 1.9m x 2.3m (+ washbasin) for new built facilities, but there is a concession to allow existing facilities with dimension no less than 1.6m x 2.0m to remain. There must also be a handrails provided on the walls but this is allowed within the minimum permitted width zone. Careful attention needs to be paid to the various door provisions, but allowances for inward swinging, outward swing and sliding doors can be made. However, a minimum unobstructed door opening width of 850 mm is required to allow a wheelchair to enter.
To get a permit to open your medical practice for business, a building certifier will need to verify that the fire safety measures at the property comply with the current building and planning legislation. This also applies if you are not planning to refit the property, but just changing the use from a shop or other type of business to a medical practice.
Areas of consideration relate to the condition of the existing fire protection services (heat and smoke detection; emergency alarms; sprinklers; fire hose reels; fire extinguishers); omissions of any mandatory requirements; and if there was to be a fire how people would exit the building, how the fire might spread both within the property and also to adjacent buildings.
It is important to note that the BCA allows for dispensation and rationalisation of any deemed “over the top” provisions. This is considered on the case by case scenario, as all buildings contain variable building and occupant characteristics. A good BCA Consultant will identify any such areas from the outset, and will be able to document the practical way forward.
In conclusion, whether buying or leasing be sure to take your time inspecting the property and look out for compliance risks to avoid any costly surprises later on. However, if there is a compliance issue it does not have to be a deal stopper. In the majority of cases a solution can be found and we recommend that you engage a qualified and experienced building professional to assist you when shortlisting and viewing properties. Health Project Services provides medical real estate and medical property consulting services for our clients.
Health Project Services provides a range of pre-lease and pre-purchase services to healthcare professionals. Our Premises Appraisal service can help you discover the risks with a potential property and explain how to mitigate them.
Input from Shane Berry, Specialist Regulations Consultant at Group DLA. Group DLA is a Sydney based Building Regulations and Certification Consultancy, providing managed solutions for clients in the property, infrastructure and construction markets. From an independent, informed position, our Building Surveying Services provide unbiased advice and assistance to the property industry, in order to understand and meet their regulatory compliance obligations. http://www.groupdla.com.au/
Disclaimer: This article represents a broad range of scenarios and we must reiterate that building and planning legislation can be quite complex and requires expert review on a property by property case in order to confirm absolute compliance.
[icon-info] Please note – this article discusses the laws and regulations that apply to new properties, or existing properties that are being upgraded. The legislation is not applied retrospectively, and therefore does not affect existing medical premises where no new building work is planned.
Top 5 key things to consider
When leasing a new premises there are some essential steps you should take to ensure you are making the best decision for yourself and your business. Commercial leases can be complicated and confusing, here we explain some of the jargon and suggest five key things to consider before you sign.
1. Is this the right location?
Researching the area will help you to determine whether this is a suitable location for your practice and if there is a need or gap in the market for your healthcare services. Look at the demographic profile of the local population – does this match the type of patient you are targeting? Investigate the level of competition from other healthcare providers – how will this shape your business? Find out if there are any new residential developments or infrastructure projects happening nearby – is this premises a good long term proposition? This type of research can help to ensure that the premises and business are in perfect synergy.
2. Can I get Council approval?
You may need to submit a Development Application so check early on that you can get approval from Council to run a medical practice from the premises. Councils have strict rules and guidelines you need to comply with and unfortunately every Council is different! A common mistake is to overlook the parking requirements. Most Councils have a minimum parking requirement for a healthcare facility, and the number of parking spaces required varies with the size of the property or number of consulting rooms. So do your own investigations or hire a professional, do not rely on the Real Estate Agent – they may not be aware of the specific requirements for your type of business.
3. Is there access for people with disabilities?
The Disability (Access to Premises – Buildings) Standards 2010 aim to achieve better access to buildings for people with a disability. It is not only good business sense to ensure more people have the opportunity to access your practice but it is also a statutory requirement. Most building works will trigger the need to comply with the Premises Standards so if there are any steps or your tenancy is over multiple levels, then a ramp or lift may need to be installed. This is particularly relevant if you are leasing a whole building as there is more responsibility on you as the lessee and these items can come with a high price tag.
4. Are the clauses and terms of the lease fair?
Commercial leases can be complicated, every premises is different and you need to ensure you have tailored lease terms that are suitable for you. Generally a lease is written in favour of the landlord, it is advisable to employ a professional to review your lease to detect any clauses/terms that may not be fair to you and need to be negotiated. Are you aware of the following?
Rent
Rent is calculated differently for commercial versus retail properties and the difference can be substantial. Do your research to establish what the rent is for similar properties to ensure you are paying a fair market value. Clarify if the rent being quoted is ‘Gross’ (including outgoings) or ‘Net’ (excluding outgoings).
Incentives
Incentives are offered by landlords to entice tenants to their property, they may take the form of a rent free period, capital works or a cash contribution to your fit out. But if you don’t ask you don’t get!
Outgoings
Outgoings are the expenses involved in physically running the building, such as insurance; repairs & maintenance; management fees; cleaning; common area lighting/heating/power. These are charged to the tenant in addition to the Net Rent so it is important to know exactly what outgoings you will be liable for and how these costs are calculated to make sure they are reasonable.
Options
When negotiated correctly Options in your lease can provide flexibility for your business. An Option to Renew gives you the right to extend your occupancy at the end of the initial lease term for a specified period of time. Another type of Option you might consider is to secure additional space for future expansion.
Rent Reviews
Rent may be reviewed during your lease and adjusted in line with the Consumer Price Index (CPI) or market value. It’s a good idea to clarify how often your rent will be reviewed and how any adjustment will be calculated so you can budget for it in your projected cashflow.
Demolition Clause
A demolition clause enables your landlord to end your lease with six months’ written notice if they wish to demolish, renovate or repair the building.
Landlord Responsibilities
Having an understanding of who is responsible for major maintenance and repairs of the building can avoid costly surprises. For example, the air conditioning system can be costly to maintain, repair or upgrade. It’s good to check what condition this is in and whether there is a regular maintenance agreement in place to keep it running smoothly. And in the event it breaks down who is responsible for repair and within what timeframe.
Make Good Provision
This is the work that you will need to undertake at the end of the lease term to restore the tenancy back to the original condition before you occupied it. Disputes can be avoided if you prepare a schedule of condition prior to your fit out and attach this to the lease so you have something to refer back to later.
5. What fit out works will I need to do?
Every property is unique and will need a different amount of fit out works depending on its existing condition, how you want to layout your practice and the desired look. It is beneficial to get a quick sketch design done by an Architect to ensure you can fit the number of consult rooms you need to run a viable business. It is also useful to get an early indication of how much it would cost and how long it would take to build to ensure the fit out at this premises will be within your budget and time limitations.