Dozens of primary care and ambulance trusts are 'fudging' official rules on directors' pay as they struggle to attract and hold on to good managers.

Large recruitment and retention bonuses, meant to be an exception, are being applied in more than 60 per cent of posts in some regions and role definitions are being stretched to escape strict bandings in the very senior managers' pay framework.

Managers say the widespread overuse of the bonuses - agreed at negotiators' discretion and without clear guidance - is skewing pay, making variations more unfair than without a framework at all.

The bandings are intended to set senior director-level pay as a proportion of the chief executive's salary, which depends on population, but are commonly worked around.

Jon Restell, chief executive of the Managers in Partnership union, said recruitment and retention payments were being made to more than 60 per cent of those on the framework in much of England and some trusts were tempted to exceed the limit of 30 per cent of salary.

"Some people are starting to say: 'This is getting so serious that if it comes to getting the right person and getting into trouble with the strategic health authority, we might just breach the framework.'"

One ambulance trust workforce director told HSJ that pay for the same roles often did not "bear any relation" to the size of organisations.

Too strict

One London PCT chief executive said PCTs were having to "fudge" or "fiddle" the rules when making new appointments to meet market rates, because the framework is too strict.

"People are becoming quite ingenious in using the flexibility of [the framework]," so that a "realistic salary" can be offered, he said. Some PCTs, mainly in London, have not moved their directors on to the Department of Health's pay framework at all.

NHS East of England director of strategy Stephen Dunn said the framework needed to be changed to ensure acute chiefs and independent sector managers moved to PCTs. "We need the flexibility to appoint the very best people," he said.

NHS Employers said the framework was "incompatible" with PCTs' need to improve to meet world class commissioning demands.

A DH spokesman said it would soon submit evidence to the senior salaries review body, which is reviewing the framework, following an independent evaluation which has not yet been published.

Are pay rules driving away talented managers? Email hsj.feedback@emap.com

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