Imperial College London Trust’s advertisement for a new chief executive could mean one of two things.

Either London’s most tumultuous trust is going to make a full-time appointment of its interim chief executive Mark Davies or it will soon appoint its third boss in 12 months.

It is not clear if Mr Davies is going to apply for the post, which he has held since last May following the departure of Steve Smith.

Neither is it clear why the vacancy was advertised, in HSJ, last week; Mr Davies, former provider development boss at NHS London, has an interim contract lasting up to two years.

What is known is that former NHS London chair Sir Richard Sykes started chairing the trust in December. The trust has said it was “always the intention” for him to lead on the appointment of a permanent chief executive.

The advert asked that candidates had “previous successful experience as a chief executive of a large complex trust”.

They will need it, because while there are two English trusts that are bigger in turnover terms (Leeds and Guy’s), there aren’t any more complex.

Already planning to breach the 2014 target for FT authorisation by a year, the multi-site, central London teaching trust has well-documented problems with solvency and a reconfiguration to tackle sooner rather than later.

There is also the new issue of a repurposed academic health science partnership. The partnership, which could involve shared services, has been looking more like a potential takeover of Chelsea and Westminster since Imperial’s neighbour announced the departure of its chief executive and chief operating officer earlier this month.