THE boss of Worcestershire's ambulance service has bagged a £50,000 pay rise, taking his salary to £232,000.
Anthony Marsh's pay is now nearly £90,000 more than the Prime Minister's £142,500.
Since the turn of the year Mr Marsh has split his duties between the West Midlands and East of England Ambulance Service, where he is also chief executive.
His pay has been defended by the service, which says it was cheaper than hiring chief executives for both organisations.
But it has led to questions over why one of the region's most important figures is being allowed to work for another trust 173 miles away in Norfolk.
He secured the job-share after being commissioned to write a report about the East of England service following worries over its poor performance.
Only a small handful of Whitehall's civil servants were paid more than Dr Marsh's current salary over the past year, one of whom was Sir David Nicholson, the former chief executive of the entire NHS, who was on £250,000.
Jonathan Isaby, chief executive of pressure group the TaxPayers' Alliance, said: "We keep hearing that the health service is facing a cash crisis, and it's little wonder when ambulance trusts pay mega salaries like these.
"It makes no sense that this deal is on par with the boss of the entire NHS.
"Taxpayers are struggling with sky-high tax bills and those funds should go on treating the sick, not feathering the nests of the top brass."
Worcester MP Robin Walker said: "Although it is a job covering an enormous area, with huge responsibilities, it does seem a surprisingly high level of pay.
"But it's a difficult one, overall it's cheaper than hiring two people.
"Whenever I have had dealings with him he does seem very capable and professional. It needs to be balanced against that."
West Midlands Ambulance Service has released a statement saying Mr Marsh works "more than 70 hours a week" across both regions.
It said: "For the combined work his salary has been increased by £50,000, saving the taxpayer approximately £130,000 on the cost of a having a substantive chief executive in each ambulance trust.
"Mr Marsh is now responsible for the running of both organisations, doing the job of two chief executives.
"He is not, however earning the salaries of two chief executives.
"West Midlands and the East of England ambulance services have a combined workforce of almost 9,000 staff, answer approximately 6,000 999 calls every day and cover a combined area of over 12,000 square miles."
The statement also said the trust in the East of England was a failing one before Mr Marsh started to turn it around, and claims both areas are getting his “full attention”.
Within the two areas there are 11 chief fire officers, and 10 chief constables.
In this region the service also covers Herefordshire, Shropshire, Warwickshire, Coventry, Staffordshire, Birmingham and the Black Country.