More than 60 per cent of managers involved in private finance initiative projects felt they lacked essential skills needed to cope with the process, according to an Institute of Healthcare Management survey.
About 50 trusts, including all those with major projects in the first three waves approved by the government, took part in the survey, which also found strong support for a radical streamlining of the PFI system.
The key areas in which skills needed to be developed were negotiating, project management and getting the most out of legal and financial advisers.
Managers also said they did not know enough about issues such as contract law, corporate finance and how the commercial sector works.
More than 60 per cent said they needed more training to handle the procurement process better.
More than 40 per cent felt that a design, build, finance and operate form of PFI would speed up the notoriously arduous process.
A quarter wanted to see more conventional Treasury finance, while others wanted a choice of capital procurement processes for different sizes and types of scheme.
The survey coincided with a promise from chief secretary to the Treasury Andrew Smith that the public sector would be helped to 'raise its game' by Partnerships UK, a private sector company being established by the Treasury to bring commercial experience and skills to the public sector.
It is due to start in the spring. Mr Smith named David Higgs, a director of Prudential plc, as chair designate, and Adrian Montague, who heads the Treasury taskforce on PFI, as deputy chair designate.
But the head of the IHM's PFI Watch, Howard Lyons, said PUK would not plug the skills gap for health managers, who required 'health specific' support.