Researchers have warned that a major government review of procedures for suspending doctors must look at the rising use of 'informal' suspensions as well as the formal disciplinary process.

Announcing the review, health minister Alan Milburn last week admitted that 'precious NHS resources are being squandered' through 'protracted suspensions'. The inquiry should concentrate on improving the system by 'speeding it up,' he said.

But health policy analysts warn that the problem could be much more widespread than official figures suggest. Since March 1995, 43 suspensions lasting longer than six months have been reported to the NHS Executive and 14 are still outstanding.

None have yet matched the most infamous case, in which paediatrician Bridget O'Connell was 'sent home' for more than a decade, at a cost of£1m.

King's Fund researcher Juan Bueza, who is studying the use of suspensions, told HSJ: 'There seems to be a rise in informal suspensions. Rather than going through the General Medical Council and disciplinary procedures, doctors are being given study leave.'

The study aims to establish whether there is a genuine rise in the use of 'gardening leave' or whether more cases are coming to light.

Mr Bueza said that if the King's Fund project did confirm a real rise 'it would suggest the structures are not working as they should'. It would mean that 'problems are not being addressed, just shuffled off'. He suggested that ministers should not use the review to save money, but as an opportunity to 'look at a profession which is resistant to change'.

Doctors agree that the current procedures are not working. Consultant neonatologist Tony Ducker of All Saints Hospital, in Chatham, Kent, was suspended for nine months at a cost of£50,000 in locum fees and salary after auditors questioned an order for equipment.

Even after his reinstatement, he was left to pay his own£25,000 legal bill.

'It is wider than a clinical issue because of the growing involvement of doctors in management,' he points out.

'If you are a clinical director you are given many things to sign that you assume are OK.'

Dr Ducker called for independent investigations with a 'review at an early stage' in both clinical and managerial disputes.

'There needs to be a quick procedure by which you can see if there is a case to answer and if you need to suspend someone at all.'