The General Medical Council (GMC) has made the practice a priority for investigation because of the risk to patients. But hospital managers say the system for disposing of bad doctors is so cumbersome they are forced to cut corners to protect their own interests.
In one case a consultant gynaecologist alleged to have carried out scores of botched operations was paid off by a North Yorkshire hospital and given a reference that enabled him to get jobs in Leicester, the Isle of Wight and London where further women were injured.
Richard Neale, who is now in private practice in Leeds, faces legal action for medical negligence and is the subject of a GMC investigation. The GMC is also investigating how the reference came to be written.
Tim Jones, of the NHS Confederation, representing hospital managers, said the problem was not unique. "I know of institutions where doctors have been persuaded that they did not have a future. There are a number of options open to a manager which might seem preferable to the full rigour of a GMC inquiry."
Managers fear that if they bring a case against an incompetent doctor it could take years, damage morale and carry heavy costs. In a case in South Wales a consultant pathologist, Bernard Charnley, accused of poor performance in reading cervical smears, has been suspended on full pay for more than five years. The total costs of the case - including his salary, that of a locum and legal bills - are estimated at more than pounds 1m.
In the Neale case, the Friarage hospital in Northallerton where he worked from 1985-95, decided that rather than suspend him, it would be cheaper to pay him off with pounds 100,000 and give him a reference, which he used to get a job at the Leicester Royal Infirmary.
Several drafts of the reference were made to ensure it was legally watertight and it was signed by Dr Michael Saunders, medical director at the time. It expressed confidence in Mr Neale as a clinician but stated he had had difficulties working at Northallerton, which had led to his departure.
The hospital is unrepentant. Steve Spoerry, director of operations, said: "We feel what we did was largely defensible."
Mr Neale had a chequered history before he arrived at the Friarage. He had already, unknown to those who appointed him, been struck off in Canada after the death of a woman in childbirth in 1981.
Doubts about his performance surfaced in 1993 and the hospital conducted a survey of local GPs and other specialists, but at that time no concerns were raised about his clinical competence.
In 1995, the hospital became worried about his failure to supervise junior doctors, monitor patients and respond to calls when he was on duty. Mr Spoerry said: "We felt we were dealing with someone who lacked judgement. We had looked into his clinical practice and had not seen cases coming back that caused us concern. But we felt something could happen."
The hospital started disciplinary proceedings but it was made clear by Mr Neale's lawyers that the process could take years. Mr Spoerry said: "Throughout that time he would be paid by us but be on `gardening' leave. While he was suspended it would be difficult to get a permanent replacement so we would face a shortage of consultants. So we offered him a pay-off.
"We decided a package worth two years' pay [pounds 100,000] was well worth doing. We thought we were getting good value for money and were protecting our service."
Mr Spoerry said writing the reference, which Mr Neale had insisted on, was the most difficult aspect. "It formed part of the legal agreement but it went through several drafts. It had to be something that Michael Saunders [then medical director] was willing to sign."
The reference expressed confidence in Mr Neale as a clinician but alluded to "difficulties", which had led to his departure from Northallerton. "It expressed confidence in him but sounded a clear warning note," Mr Spoerry said.
The warning was not picked up by Leicester Royal Infirmary, which took him on as a locum. However, his contract was terminated after an altercation with a porter. When Leicester discovered his background, it complained in the strongest terms to the Friarage that it had been misled.
Mr Neale, whose career was traced in a BBC Panorama programme last month, later worked at St Mary's hospital in the Isle of Wight, and at the private Portland hospital in London. Last summer an "alert" letter about him was circulated to the NHS by the Northern and Yorkshire regional chief executive, Professor Liam Donaldson, now the Government's chief medical officer.
Mr Neale has not worked in the NHS since. He could not be contacted for comment.Reuse content