Feature / Split decision

Finance managers benefit from experience in both provider and commissioner settings but there are few recent examples of senior professionals making the leap. Seamus Ward talks to those who have jumped between sectors

Tim Evans is one of a select band of NHS finance managers. A little less than four years ago he took a step that fewer and fewer senior finance staff are taking when he moved from his position as director of finance at Blackpool, Fylde and Wyre Hospitals NHS Trust to become finance director at Bolton Primary Care Trust. He has not looked back, becoming deputy chief executive within six months of his arrival and then chief executive more than two years ago.

He spent 11 years as finance director of trusts across the North West, first at Furness General Hospital and then at Blackpool, Fylde and Wyre.

‘I felt I had been through the same cycle for 11 years,’ he says. ‘I had moved to bigger and bigger organisations but the finance cycle was the finance cycle and it got a bit boring. I also think you lose effectiveness when you become part of the furniture and I felt I was being typecast as an acute finance director when I had a wider role to play.’

Career focus

The NHS job market is a fluid one but staff tend to move between the same types of organisation. This is becoming increasingly true in the finance function, particularly in more senior jobs, as accountants develop their careers and define themselves as provider or commissioner finance managers.

Heather Clarke, business manager at Hays Accountancy and Finance, says there are a number of barriers preventing easy switching between the two sectors.

‘It is very difficult and very rare for a finance director to move between a PCT and an acute trust,’ she explains. ‘The roles are vastly different and require a strong background in their individual areas. Experience in either area is not only desirable, it is necessary.

‘A finance director working in an acute trust will need reporting experience and exposure in this area, as well as cost control experience. A director working in the commissioning arm will need understanding of the commissioning relationships.’

Ms Clarke says it has become increasingly difficult for finance professionals to decide between the two, as they now qualify in one organisation rather than gaining exposure to both as was once the norm.

‘Those that want to move will need to do so earlier on in their career. The movement between PCTs and acute organisations is much more fluid at a lower level,’ she says.

‘Financial accountants and chief accountants will find the transition relatively straightforward, as at this level both roles focus on statutory accounting. Salaries are usually higher in acute organisations, although the budgets are smaller.’

The salary gap between PCTs and acute trusts is often cited as the greatest barrier to the freer movement between sectors. An HFMA survey last year found finance managers agreed that a rounded understanding of how the whole of the NHS works was desirable as preparation for senior roles but pay differentials between sectors restricted movement.

Senior manager incentives

PCT finance directors’ pay is governed by the very senior managers’ pay framework and substantial top-ups were needed to convince trust or foundation trust finance directors to move to PCTs, the survey found. The differential between trust deputy director of finance pay (typically band 8D – from £63,833 to £79,031 from 1 April) and that of PCT finance directors was seen as too narrow in some cases.

At deputy level and below, where pay in both trusts and PCTs is governed by Agenda for Change, there was a perception that pay can be an obstacle with PCT and trust roles evaluated (and thus paid) differently.

Wiltshire Primary Care Trust finance director Charlotte Moar, who joined last year from Swindon and Marlborough NHS Trust, where she was also finance director (see box right), says there are some barriers to moving between sectors.

‘Provider finance directors are paid more than commissioner finance directors and I don’t know if that’s right or wrong,’ she says.

‘I think that given the reconfiguration in PCTs, people felt they were a less secure place to be. I feel there should be positive encouragement to switch between provider and commissioner. I would also encourage people into [GP] practice management, where they can gain excellent access to and knowledge of how primary care works.’

Practical challenges

Mr Evans does not believe it is difficult to move between sectors, though he acknowledges there are some practicalities to be overcome. ‘You must be geographically mobile and there are questions about relative salaries. But if you are moving from a medium-sized acute trust you will find something that will give you a similar or improved level of salary,’ he says.

He dismisses any notion that acute trusts offer more rewarding jobs with better career prospects – a perception offered by many as another reason preventing greater flow of finance staff from trusts to PCTs.

‘PCTs do not employ large numbers of staff directly,’ says Mr Evans, ‘but there is the really exciting aspect of being responsible for your local population – improving their health, reducing health inequalities and preventing them from needing more specialised services. It’s a much more complex, interesting job because you serve a particular community.’

He has made a virtue of moving around the system. He trained with the civil service, where he became a founder member of the NHS trust finance team before joining the NHS in 1992. Initially he worked at the South Thames NHS Executive, developing monitoring and performance management in the region, before moving to the North West in 1994. He believes the benefits of switching between organisations are clear.

‘There is something there about empathy when you are negotiating; where you realise the need to understand the other side of the table. You have to operate on an inter-personal basis and not to personalise the issues – sometimes relationships break down because people personalise issues but it helps if you understand why people are taking particular positions.’

He adds: ‘People should do what’s right for them, They may feel they are suited to a particular role and that’s fine. However, I think I am better for having moved around and it’s part of the reason why I have been able to move from finance into the general management role.’

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