In our series profiling people in contrasting roles, Jeremy Davies talks to two managers who have found job satisfaction in different parts of the independent sector

Homeless advocacy project coordinator, The Big Issue in the North , Manchester Salary:£18,500 Maggie Harding, 37, helped set up the project, which aims to improve homeless people's access to health services, two years ago. Based at a primary care centre in The Big Issue in the North 's offices, it has funding until next April under the NHS Seizing the Opportunities initiative.

What was your career path?

While at university, where I studied English and American literature, I worked as a volunteer on the Manchester soup run, which delivered food to homeless people at Piccadilly. After a couple of years dabbling in the antique costume business, I started work with the homeless, first as a volunteer, then later in paid roles with the city council. I wanted a challenge and this project wanted someone with experience of working with the homeless.

Describe your job

There are two aspects to the work. The first is conducting an action research project to identify gaps in information and services, and to help improve service delivery.

There are huge problems for homeless people in gaining access to healthcare, even just getting registered with a GP. Because GPs are paid on a capitation basis, the system actively discriminates against homeless people, especially if they're very itinerant. We recognise GPs' problems and that homeless people often present with very complex health needs. To help persuade GPs to take homeless people on we register them here, and then try to set up a registration interview with their local GP. I go to these meetings, and we chase up clients to attend appointments. I also sort out detailed records for the GP.

The second part of my work is to manage provision of primary care services here at the health centre. We have two GPs, a practice nurse, a community psychiatric nurse, an alcohol worker and a drug worker. Services are available to all homeless people, not just Big Issue vendors.

I report to GP Dr Gerry O'Shea, who runs the surgery as a branch surgery to his other practice. Funding for my salary, and that of my linkworker colleague, comes from the health authority.

How many hours a week do you work?

I think it says 37 on my contract, but it's probably more like 40 to 42.

What aspects of your job do you most enjoy?

I really like the people I work with. It's usually frantic here, which is how I like it. And I love the clients. So many of them have such a good sense of humour and are optimistic, even when they have nothing and stagger in here filthy and in a terrible state. It's great when you see people starting to stand on their own feet and getting tenancies.

What aspects are the most frustrating?

The biggest frustration is clients not keeping appointments. Sometimes you can have taken ages setting up a much-needed appointment with a specialist and they just don't turn up. Some clients have failed to turn up for 30 or 40 appointments.

What has been the high point of your career?

Creating my own database. I did it all from scratch. It contains all our clients' personal details, including information useful for the health authority like whether they've been registered with a GP before, and whether they've used accident and emergency instead of going to their GP.

What has been the worst moment?

Clients can have life-threatening symptoms like blood clots or septicaemia, which they leave until the last minute and end up having to go into hospital as an emergency. Recently an 18-year-old lad died and, even though it's part of my job to deal with things like that and I've developed coping strategies, it still hit me hard.

What has been the biggest challenge of your career so far? Starting this whole programme from scratch.

What is your biggest challenge for the next year?

Trying to secure funding to keep the project going and expand it. I'd like this project to cover the whole of the city, with about 50 linkworkers - but I need more bodies at the office to free me up to work on the strategy, planning and publicity.

What's been the hardest thing you've had to do?

I once had to help the doctor take out some stitches from a man's arm. They'd been there for three months and the skin had grown over them. It was awful.

How do you unwind?

I'm really into antique costume. I spend hours going round car boot sales picking up bits and pieces and renovating them. My claim to fame is that I renovated a Charleston dress for Brideshead Revisited , which meant hand-stitching 9,000 beads.

Could you see yourself working for a private hospitals group? Absolutely not. I'm totally opposed to private healthcare.

Hospital director, Grovelands Priory Hospital, north London Salary:£45-50,000 package David Cole, 36, has managed this 58-bed psychiatric unit, which treats NHS and private patients for a wide range of psychiatric disorders, since 1996. The hospital is owned by Priory Healthcare, a national, private healthcare group which operates 13 psychiatric hospitals, a childcare services division and a dialysis service.

What was your career path?

I qualified as a registered mental nurse from West Park, Epsom, in 1987. My first job was as a staff nurse in an addictions unit. I then moved to south Wales as part of a drug and alcohol team before returning to Gloucestershire in general and community psychiatry.

While there I had the opportunity to do a joint health and social services secondment in service development, which eventually led to a substantive management post at Winchester and Eastleigh trust. At Winchester I was involved in gaining contracts from neighbouring trusts and found I had an entrepreneurial streak. When the Priory job came up I saw an opportunity to capitalise on that.

Describe your job

I have full responsibility for what goes on at the hospital, including negotiating a budget, setting and achieving activity targets, business development, managing services to achieve our plans, and meeting quality and clinical governance requirements. I have a five-member senior management team, made up of the director of clinical services, medical director, hotel services manager, accounts manager and marketing manager. We have 90 permanent staff, six 'staff ' consultants and a large number of bank staff and visiting consultants.

My main fixed commitment is a weekly meeting with the senior management team. I report to the London regional director.

How many hours a week do you work?

I start at 7.30am. On a normal day I finish at around 5.30pm, but this job involves a great deal of relationship building with consultants and other partners within and outside the NHS, so it can mean a lot of evening meetings.

What aspects of your job do you most enjoy?

Seeing things happen quickly. Unlike the NHS, here I have the freedom to implement decisions without getting bogged down in bureaucracy.

What aspects are most frustrating?

Not being able to predict activity. This is a big problem in the private sector generally, and planning to manage activity can be difficult, especially in a highly competitive environment. We have to forge and maintain long-term relationships with NHS and private purchasers.

What has been the high point of your career?

It's very difficult to say, but in the past year I really enjoyed working on a joint evaluation with King's College Hospital of a 3,000-bed hospital in Cairo for the Egyptian government. It was fascinating to see inside a different health service.

What has been the worst moment?

I went through several management reorganisations in the NHS where friends and colleagues lost their jobs, and mine came under threat. Fortunately I managed to stay one step ahead of the game, but they were unsettling times.

What has been the biggest challenge of your career so far?

Responding to the challenges of clinical governance has been really tough, but it has helped me develop. In the NHS clinical governance is not easy, but at least you are the consultants' employer, so there's some automatic element of control in your relationship. Here I'm dealing with self-employed contractors, so my only hope is to win their support on things like poor performance policies - and to do so in a very visible way, because everyone likes to knock the private sector.

What is your biggest challenge for the next year?

Finding new niche areas of business. We get around 60 per cent of our business from private medical insurance companies and individuals. The remaining 40 per cent comes from the NHS - partly out-of-area treatments and partly overspill patients from mainstream psychiatric services. But this has been on the wane since Labour took over. I think it's been made clear to NHS purchasers that the more they spend in the private sector, the less they will get to spend overall.

We have to turn such threats into opportunities and find ways of working with NHS partners that fit in with their agendas. We recently opened a dedicated service for adolescents with acute psychiatric problems, for example.

What's been the hardest thing you've had to do?

Adapt very quickly, when I first got this job. Not only did it involve moving to London, but I also had to throw a lot of time and energy into understanding the history of the place and the market it's in. Maintaining your market share in a very competitive marketplace is not easy.

How do you unwind?

In the rugby season by shouting my head off at Gloucester Rugby Club matches. The rest of the time, cooking, cycling, eating and drinking.

Could you see yourself working in the not-for-profit sector?

More so than for the NHS, but only if it allowed me autonomy and the ability to get things done.