Primary Health Properties — Stability with income growth

Real Estate

Primary Health Properties

Stability with income growth

2023 results

Real estate

5 March 2024

Price	90p
Market cap	£1,203m
Net debt (£m) at 31 December 2023		1,306
Net LTV at 31 December 2023		47.0%

Shares in issue	1,336.5m
Free float	97.4%
Code	PHP

Primary exchange	LSE
Secondary exchange	JSE

Share price performance

%	1m	3m	12m
Abs	(3.4)	(9.0)	(14.5)
Rel (local)	(3.8)	(11.0)	(11.2)

52-week high/low

107p

86p

Business description

Primary Health Properties is a long-term investor in primary healthcare property in the UK and the Republic of Ireland. Assets are mainly let on long leases to GPs and the NHS or HSE, organisations backed by the UK and Irish governments, respectively. The tenant profile and long average lease duration provide an exceptionally secure rental income stream.

Next event

Half-year 2024

30 June 2024

Analyst

Martyn King

+44 (0)20 3077 5700

financials@edisongroup.com

Edison profile page

Primary Health Properties is a research client of Edison Investment Research Limited

The key feature of Primary Health Properties’ (PHP’s) 2023 results was the further acceleration in rental uplifts, rising at the fastest pace for 15 years. This is driving organic earnings growth to fully cover progressive dividends, which are now in the 28th year of unbroken increase.

Year end	Net rental income (£m)	Adjusted earnings* (£m)	Adjusted EPS** (p)	NAV per share*** (p)	DPS (p)	P/NAV (x)	Yield (%)
12/22	141.5	88.7	6.6	112.6	6.50	0.81	7.1
12/23	151.0	90.7	6.8	108.0	6.70	0.84	7.4
12/24e	154.3	92.4	6.9	107.1	6.90	0.84	7.7
12/25e	157.9	93.3	7.0	109.4	7.00	0.82	7.8

Note: *Excludes valuation movements, amortisation of fair value adjustment to acquired debt and other exceptional items. **Non-diluted. ***Defined as adjusted EPRA net tangible assets (NTA) excluding fair value of derivative interest rate contracts and convertible bond, deferred tax and fair value adjustment on acquired debt.

Driven by accelerating rental growth

Open market rent reviews (67% of the total) continue to accelerate and should maintain rental growth as inflation softens. Combined with one of the lowest cost ratios in the sector and 97% of debt costs fixed/hedged, this should drive further fully covered DPS growth. This assumes no benefit from acquisitions, which should look more attractive as interest rates fall and rents increase. For the new developments needed to modernise healthcare estates to be viable, the rents need to increase 20–30%, but PHP sees some signs of this being recognised by commissioners. 2023 DPS of 6.70p (+3.1%) was 1.01x covered by adjusted EPS and the Q124 DPS of 1.725p indicates a 2024 DPS of 6.9p. More robust than the wider property sector, a 23bp yield widening (to 5.05%) was partly offset by rental growth. NAV per share was 4.1% lower at 108p but NAV total return was 1.8%. Our income earnings forecasts show no material change.

Well-placed to meet health service investment needs

The long-term need for primary healthcare facilities is driven by demographic trends and is relatively unaffected by economic conditions. In both the UK and Ireland, populations are growing and ageing, with more complex healthcare needs. Increased use of online and telephone appointments, particularly for frontline triage, has done nothing to reduce the need for modern, integrated, local primary healthcare facilities. Not only will these better serve patients with an extended range of procedures, available locally, they will reduce pressures on the hospitals and support the NHS to reduce the treatment backlog. PHP is well-placed to help meet this need for investment and signals that it will remain the focus of its strategy.

Valuation: Secure and growing income

Visible, secure and growing income is the core of the PHP investment case. Leases are long and substantially upward-only, 89% backed directly or indirectly by government bodies, with little exposure to the economic cycle or fluctuations in occupancy. The rise in interest rates has driven up the prospective dividend yield to more than 7% despite accelerating rent growth, underpinning the prospects for further growth in income and dividends. The 10-year UK gilt yield is 4.1%.

Rental growth drove the increase in earnings and supported property values

Rental uplifts have reached the highest level in 15 years

During 2023, rental uplifts were the main driver of the c £5.5m, or 3.8%, increase in annualised contracted rent roll to £150.8m. Rent reviews added £4.0m and asset management projects a further £0.3m,1 and management expects the increase in rental growth to continue in 2024.

1 The other increase in rent roll represents the balance of acquisition (£1.6m) net of lease surrenders and expiries, and FX movements.

Exhibit 1: Rental growth is continuing to accelerate*

Source: PHP data. Note: *Average annualised uplift on completed UK rent reviews.

UK rent reviews are typically on a three-year revolving basis and effectively upward only, at the option of the landlord. Irish rents (c 9% of the total) are linked to Irish CPI and are reviewed every five years. Recent inflation is yet to fully feed through the UK three-year review cycle, but the acceleration of open market reviews should offset the eventual slowdown. After many years of very modest uplifts, high levels of land and building cost inflation, particularly in the past couple of years, are increasingly being recognised.

Exhibit 2: Annualised rental uplifts on completed rent reviews in the period

	2023	2022	2021	2020
UK – open market	1.8%	1.5%	1.5%	1.3%
UK – indexed	8.4%	7.4%	2.8%	2.3%
UK – fixed	2.7%	3.1%	2.9%	2.7%
Total UK	4.0%	3.4%	1.7%	1.8%
Ireland – indexed	3.3%	2.6%	0.8%	1.1%
Total annualised increase	4.0%	3.4%	1.7%	1.8%

Source: PHP

Property valuations were robust

The 2023 property revaluation deficit of £53.0m, or 4.0p per share, was driven by a 23 basis point (0.23%) widening of the EPRA net initial yield to 5.05%, with the impact substantially mitigated by rental growth and asset management. Yield widening reduced values by c £128m with rental growth and asset management having a positive impact of c £75m.

Due to its defensive nature, healthcare property valuations have been more robust than the broader sector during the re-pricing of assets in the past two years. For PHP in particular, 89% of rental income is paid by the UK and Irish governments, occupancy is effectively full (99.3%) and the weighted average unexpired lease length is more than 10 years.

With inflation falling significantly and money markets anticipating that interest rates have peaked and will soon begin to fall, PHP is hopeful that valuation declines with continuing rental growth offsetting any further modest widening of yields.

Highly selective investment stance

PHP’s cautious approach to investment activity continued in 2023, waiting for the economic and interest rate environment to become clearer, and where it can proceed on an accretive basis. It made just one acquisition, late in 2023, and has just one development project on site. The Croft Primary Care Centre in West Sussex, being built to net zero carbon standards, is expected to reach practical completion in Q324.

The immediate pipeline of external investment opportunities includes one development project where it has managed to work with both the local council and integrated care board (ICB)2 to make the scheme economically viable. More generally, PHP estimates that to compensate for much higher costs, to make new development economically viable and bring forward schemes that are much needed by the NHS, agreed rents need to be 20–30% higher.

2 An integrated care board (or ICB) is a statutory NHS organisation that is responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in a geographical area.

Ireland remains PHP’s preferred area of future investment activity, with similar market dynamics to the UK from a lower cost of capital and higher property yields. Over the medium term, the company targets an increase in the Irish share of the portfolio from the current 9% to c 15%, for which the January 2023 acquisition of Axis will provide meaningful support.

Asset management projects create value by increasing rents and extending lease lengths. The 2023 initiatives will increase rental income by £0.3m pa and will extend the lease to more than 15 years, for an investment of £5.2m. A further 23 asset management projects and lease regears are planned over the next two years, with £19.3m of investment to create additional rental income of £0.8m pa and extend the average unexpired lease term to back over 20 years.

Exhibit 3: Summary of investment pipeline

	In legals		Advanced pipeline		Total cost
	Number	Est cost	Number	Est cost
Ireland – forward funding			2	£43.3m/c €50m	£43.3m/c €50m
UK direct developments	1	£3.3m	2	£11.5m	£14.8m
UK investments
Total external investment	1	£3.3m	4	£54.8m	£58.1m
UK asset management projects	23	£19.3m	20	£16.3m	£35.6m

Source: PHP

2023 results

Adjusted earnings increased by £2.0m or 2.3% during the year, with strong growth in net rental income (up £7.8m) and a first-time contribution from Axis (£1.1m) partly offset by higher administrative and interest costs (up £2.0m and £4.9m, respectively).

The increase in net rental income included £4.6m of additional income from completed rent reviews and asset management projects (including the impact of rent reviews backdated to the original date of review), a £2.5m impact from acquisitions, disposals and developments completed in 2023 and 2022 and a £0.7m reduction in non-recoverable property costs.

The £2.0m increase in administration costs was mainly due to a £1.1m increase in the provision for performance-related pay and the cost of a voluntary redundancy programme, which PHP expects to reduce costs by c £0.5m pa. The 2022 comparative benefited from a one-off adjustment to historical performance fee arrangements.

The EPRA cost ratio of 10.7% remains one of the lowest in the UK REIT sector.

Increased net financing expense primarily reflects increased average debt and the impact of higher interest rates on the small amount of floating rate debt.

In addition to the 4.0p per share property valuation deficit, intangible assets of 0.5p per share acquired with Axis are excluded from adjusted EPRA net tangible assets (NTA) per share, 4.6p lower at 108p.

Exhibit 4: Summary of earnings 2023

£m unless stated otherwise	2023	2022	2023/2022
Net rental income	149.3	141.5	5.5%
Axis contribution	1.1	0.0
Administrative expenses	(11.6)	(9.6)	20.8%
Net finance expense	(48.1)	(43.2)	11.3%
Adjusted EPRA earnings*	90.7	88.7	2.3%
Amortisation of fair value adjustment on acquired debt	3.0	2.9
EPRA earnings	93.7	91.6	2.3%
Property revaluation	(53.0)	(64.4)
Profit on sale of properties	0.0	2.9
Fair value gain/(loss) on interest rate derivative & convertible bond	(13.2)	26.8
Amortisation of Axis intangible	(0.9)
Axis acquisition costs	(0.5)
Deferred tax charge	1.2	(0.6)
Basic IFRS earnings	27.3	56.3
Basic IFRS EPS (p)	2.0	4.2
Basic EPRA EPS (p)	7.0	6.9
Basic adjusted EPRA EPS (p)	6.8	6.6	2.2%
DPS (p)	6.70	6.50	3.1%
Dividend cover** (x)	1.01	1.02
Adjusted EPRA NAV per share (p)***	108.0	112.6
EPRA NAV total return	1.8%	2.0%
Investment portfolio (bn)	2.78	2.80
Portfolio net initial yield (NIY)	5.05%	4.82%
Net LTV	47.0%	45.1%
EPRA cost ratio	10.7%	9.9%

Source: PHP data, Edison Investment Research. Note: *Adjusted EPRA earnings excludes valuation movements, amortisation of acquired fixed rate debt revaluation and other exceptional items. **Dividend cover is EPRA earnings as a percentage of dividends declared. ***Adjusted EPRA NAV excludes fair value movements in derivative interest rate contracts and convertible bonds, acquired fixed rate debt revaluation and deferred tax.

Strong balance sheet

PHP has a strong balance sheet. Debt facilities are well spread by lending source and maturity, with an average maturity of more than six years. Of the drawn debt, 97% is fixed rate or hedged, with an average rate of 3.3%. Allowing for capital commitments, it has more than £300m of undrawn headroom.

The net loan to value ratio of 47.0% is within the company’s target range of 40–50%. Although above the LTV range for more mainstream listed UK commercial property investors, this should be seen in the context of the exceptional strength of the tenant covenant, the essential nature of the assets and long leases with upwards-only3 rent reviews. Net debt/EBITDA is more than 9x. It would take a 39% decline in portfolio value, or an implied 8.0% net initial yield, to challenge covenant headroom. Rightly in our view, PHP has reiterated its comfort with its balance sheet structure and, for the avoidance of doubt, confirmed that it has no plans to reduce borrowing by raising equity.

3 It is possible for Irish rents to be negatively indexed to inflation but this seems a remote prospect.

Minimal change to earnings forecasts

There is no material change to our 2024 earnings forecast and we expect further progress in earnings and fully covered DPS in 2025 (+1.4%), driven by organic rental growth.

Our forecasts had not allowed for market-wide property yield expansion in H223 and our forecast EPRA NTA per share is consequently lower.

Exhibit 5: Forecast summary

		Revised forecast		Previous forecast		Change
	2023	2024e	2025e	2024e	2025e	2024	2025
Net rental & related income (£m)	151.0	154.3	157.9	155.7	N/A	-0.9%	N/A
Adjusted earnings (£m)	90.7	92.4	93.3	91.9	N/A	0.5%	N/A
Adjusted EPS (p)	6.8	6.9	7.0	6.9	N/A	0.4%	N/A
DPS (p)	6.7	6.9	7.0	6.9	N/A	0.0%	N/A
Dividend cover (x)	1.01	1.00	1.00	1.00	N/A	0.4%	N/A
Adjusted EPRA NTA per share (p)	108.0	107.1	109.4	111.6	N/A	-4.0%	N/A
LTV	47.0%	47.8%	47.6%	45.6%

Source: PHP 2023 data, Edison Investment Research forecasts

Progressive, fully covered DPS

PHP is already in its 28th year of unbroken DPS growth and we expect further increases in FY24 and FY25, fully covered by adjusted earnings. The expected 2024 DPS of 6.9p represents a 3.0% increase on 2023 and would take five-year growth to 4.4% pa.

Exhibit 6: Now in the 28th year of unbroken dividend growth

Source: PHP data

Stable and growing dividends are central to the PHP investment case, although secure, upwards-only rental growth supports capital growth over time. Over 10 years, PHP has consistently generated income returns (on NTA), with an average of 5.6% pa (and 6.0% in 2023). NTA per share has also increased over the same period, by an average 3.5% pa.

Exhibit 7: 10-year income and capital returns

Source: PHP data, Edison Investment Research

Exhibit 8: Financial summary

Year end 31 December (£m)	2021	2022	2023	2024e	2025e
PROFIT & LOSS
Net property income	136.7	141.5	151.0	154.3	157.9
Administrative expenses	(10.5)	(9.6)	(13.7)	(12.7)	(13.0)
Operating profit before revaluation movements and non-recurring items	126.2	131.9	137.3	141.6	144.9
Net realised and unrealised portfolio gains/(losses)	110.5	(61.5)	(53.0)	(16.9)	31.8
Exceptional items related to corporate acquisition	(37.0)	0.0	0.0	0.0	0.0
Operating profit before financing costs	199.7	70.4	84.3	124.7	176.6
Finance income	0.8	0.9	0.2	0.0	0.0
Finance expense	(60.5)	(41.2)	(45.2)	(47.2)	(49.5)
Fair value movement on swaps and convertible bond	1.6	26.8	(13.2)	0.0	0.0
Profit Before Tax	141.6	56.9	26.1	77.5	127.1
Tax	(1.5)	(0.6)	1.2	0.0	0.0
Profit After Tax	140.1	56.3	27.3	77.5	127.1
Adjusted for the following:
Net realised/unrealised gain/(loss) on investment property	(110.5)	61.5	53.0	16.9	(31.8)
Fair value gain/(loss) on derivatives & convertible bond	(1.6)	(26.8)	13.2	0.0	0.0
Other adjustments	26.1	0.6	0.2	1.0	1.0
EPRA earnings	62.1	91.6	93.7	95.4	96.3
Other non-recurring charges	29.0	0.0	0.0	0.0	0.0
Amortisation of fair value adjustment to acquired debt	(3.2)	(2.9)	(3.0)	(3.0)	(3.0)
Other adjustments	(4.7)	0.0	0.0	0.0	0.0
Adjusted earnings	83.2	88.7	90.7	92.4	93.3
Period end number of shares (m)	1,332.9	1,336.5	1,336.5	1,336.5	1,336.5
Average Number of Shares Outstanding (m)	1,330.4	1,334.8	1,335.7	1,336.5	1,336.5
Fully diluted average number of shares outstanding (m)	1,435.8	1,443.7	1,444.6	1,445.4	1,445.4
Basic IFRS EPS (p)	10.5	4.2	2.0	5.8	9.5
Adjusted EPS (p)	6.2	6.6	6.8	6.9	7.0
Dividend per share (p)	6.20	6.50	6.70	6.90	7.00
Dividend cover (Adjusted earnings/dividends paid)	101%	102%	101%	100%	100%
Adjusted EPRA NTA total return	8.9%	2.0%	1.8%	5.6%	8.7%
EPRA cost ratio	9.3%	9.9%	10.7%	10.7%	10.6%
BALANCE SHEET
Non-current assets	2,801.4	2,816.3	2,786.9	2,786.1	2,826.9
Investment properties	2,795.9	2,796.3	2,779.3	2,777.4	2,819.2
Other non-current assets	5.5	20.0	7.6	8.7	7.7
Current Assets	51.7	48.2	40.0	45.7	43.1
Cash & equivalents	33.4	29.1	3.2	8.9	6.3
Other current assets	18.3	19.1	36.8	36.8	36.8
Current Liabilities	(70.5)	(64.1)	(71.2)	(68.8)	(68.8)
Current borrowing	(2.2)	(2.3)	(2.4)	0.0	0.0
Other current liabilities	(68.3)	(61.8)	(68.8)	(68.8)	(68.8)
Non-current liabilities	(1,282.7)	(1,318.2)	(1,331.8)	(1,353.8)	(1,358.4)
Non-current borrowings	(1,273.0)	(1,297.1)	(1,320.9)	(1,342.9)	(1,347.5)
Other non-current liabilities	(9.7)	(21.1)	(10.9)	(10.9)	(10.9)
Net Assets	1,499.9	1,482.2	1,423.9	1,409.2	1,442.7
Derivative interest rate swaps	(4.4)	(7.1)	(4.7)	(4.7)	(4.7)
Change in fair value of convertible bond	21.6	(7.1)	(2.3)	(2.3)	(2.3)
Other EPRA adjustments	38.8	36.8	26.1	29.2	26.2
Adjusted EPRA net tangible assets (NTA)	1,555.9	1,504.8	1,443.0	1,431.4	1,461.9
IFRS NAV per share (p)	112.5	110.9	106.5	105.4	107.9
Adjusted EPRA NTA per share (p)	116.7	112.6	108.0	107.1	109.4
CASH FLOW
Operating Cash Flow	140.4	117.6	133.6	142.6	145.9
Net Interest & other financing charges	(46.6)	(42.4)	(47.1)	(47.6)	(49.9)
Tax	0.0	0.0	0.0	0.0	0.0
Acquisitions/disposals	(129.3)	(74.8)	(39.5)	(15.0)	(10.0)
Net proceeds from issue of shares	(0.1)	(0.1)	0.0	0.0	0.0
Debt drawn/(repaid)	82.8	48.8	23.6	20.0	5.0
Equity dividends paid (net of scrip)	(74.4)	(81.6)	(89.5)	(92.2)	(93.6)
Other cash movements and FX	(43.6)	28.9	(7.0)	(2.1)	0.0
Net change in cash	(70.2)	(4.3)	(25.9)	5.7	(2.6)
Opening cash & equivalents	103.6	33.4	29.1	3.2	8.9
Closing net cash & equivalents	33.4	29.1	3.2	8.9	6.3
Debt as per balance sheet	(1,275.2)	(1,299.4)	(1,323.3)	(1,342.9)	(1,347.5)
Convertible bond fair value adjustment	21.6	(7.1)	(2.3)	(2.3)	(2.3)
Unamortised borrowing costs	(13.7)	(15.3)	(12.7)	(10.1)	(7.5)
Fair value of acquired debt	34.4	31.4	28.4	25.4	22.4
Closing net debt/(cash)	(1,199.5)	(1,261.3)	(1,306.7)	(1,321.0)	(1,328.6)
Net LTV	42.9%	45.1%	47.0%	47.8%	47.6%

Source: PHP historical data, Edison Investment Research forecasts

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This report has been commissioned by Primary Health Properties and prepared and issued by Edison, in consideration of a fee payable by Primary Health Properties. Edison Investment Research standard fees are £60,000 pa for the production and broad dissemination of a detailed note (Outlook) following by regular (typically quarterly) update notes. Fees are paid upfront in cash without recourse. Edison may seek additional fees for the provision of roadshows and related IR services for the client but does not get remunerated for any investment banking services. We never take payment in stock, options or warrants for any of our services.

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