Laura Donnelly interviews the new chief executive of East Midlands SHA

'The minute primary care trusts were created I became Mrs PCT, and every time anybody in the Department of Health wanted to know anything about PCTs it was &Quot;ask Barbara&Quot;.'

So Dr Barbara Hakin sums up the point in her career when she went from part-time GP to a player on the national policy stage.

After 20 years in part-time practice, in the late '90s she became fundholding manager, then took charge of a multifund, and then, with the creation of primary care groups, became a chair. When primary care trusts were created, she decided it was time to take the management 'jump': in 2000 she became chief executive of Bradford South and West PCT.

She had already developed 'a bit of a national profile' catching the attention of then health secretary Alan Milburn for her work developing GPs with special interests, 'probably the thing I am most proud of'. This gave her a place on the teams creating the NHS plan and NHS modernisation board.

When it became clear that all primary care groups would become PCTs, she took on the development programme run by the National Primary and Care Trust Development Programme, all the while keeping her own chief executive post. Then followed a national role at the Modernisation Agency, then PCT adviser for the Department of Health.

A year ago she was made lead negotiator on the review of the general medical services contract, and soon after programme director for the four PCTs soon to become Bradford and Airedale PCT.

By January, she had been asked to support Sir Ian Carruthers, who had just been made acting director of commissioning. By March, the departure of NHS chief executive Sir Nigel Crisp pushed Sir Ian up the ladder, with Barbara taking his old role on an acting basis. At the same time, she was still renegotiating the contract and running the four PCTs.

She takes a deep breath. 'And here I am now. I've got one job. Oh, and one sideline, because it's likely I will continue to renegotiate the GMS contract.'

Experience taking on a number of roles is 'probably one of the main things I can bring into this SHA role ? it's not a job for people who want to do it themselves, it's a job for those who can inspire, motivate and co-ordinate others.'

If the last six years have seen her national profile rise, it would be a mistake to discount the relevance of her earlier career, she suggests.

'Perhaps people see me as relatively inexperienced, but I've had 20 years of delivering at the sharp end. I would question whether I would have been better with another 20 years of being a manager rather than 20 years of thoroughly understanding the patient pathway,' she challenges.

She describes how a GP's ability to extract information from patients, unpick complex problems, influence behaviours and manage the risks of a range of solutions echoes some of the challenges she now faces.

Which leads her to another concern about assumptions made by fellow NHS managers.

'It does somewhat dismay me when someone assumes accountants are more likely to solve NHS problems than doctors and clinicians. Well hang on ? finance is critically important but there's quite a limit to what you can do just by moving the figures around ? and there's been rather too much of that at year-end. The vast majority of NHS resource is committed by GPs' pens.'

Anyway, what does Dr Hakin reckon her colleagues make of her? 'People say I give them energy, it sounds a bit trite, but I think people do feed off that. I'm not frightened to do things differently and therefore I make it quite exciting. I've got a very strong sense of fair and I guess I'm quite fun. It's a very serious business, but it doesn't mean you have to be serious all the time. The clinical background puts you up at the sharp end of life and death and you learn that sometimes you can do your best for people by being slightly distanced... which includes being able to have a laugh when things go wrong.'

'Hmm. What else' I'm famous for my shoes. [HSJ has previously referred to Dr Hakin as the Imelda Marcos of the NHS]. But nobody seems to have noticed I look like Julie Walters ? yet.'

And what would her critics say? Dr Hakin gives an admirably long list of flaws, of which this is a mere summary: driving very hard, sometimes too hard, not being clear enough in her direction, being a bit last minute, never finishing her sentences ? she trails off.

'Oh and one last thing ? when I get cross I get cross.' l