Patients are to get a say in doctors' merit awards which mean some can double their earnings.

The government has announce changes to the merit awards which can reach up to �50,000 a year in an effort to make them 'fairer and more open'.

The move follows Health Secretary Frank Dobson's criticism of news that one of the surgeons banned from practising after the Bristol heart babies scandal was keeping his Grade A award.

James Wisheart was found guilty of serious professional misconduct over the deaths of 29 babies following heart operations at the Bristol Royal Infirmary.The hospital had a much higher than average death rate for the operation.

Health minister Alan Milburn said the changes had not been prompted "purely" by the Bristol case, but he said doctors who were found guilty of serious professional misconduct would not get merit awards.

Mr Dobson has promised to look at the possibility of removing Mr Wisheart's award.

Fairer

The government will reform the Committee on Distinction Awards to ensure patients, women and people from ethnic minorities are fairly represented.

It will also allow the government to withdraw awards from consultants who are deemed not to come up to scratch.

The government says the reform is only the first step in a fundamental review of the system, which will be brought in next year.

NHS employees and patients will get a say

Currently, awards are paid annually for an entire career.

But, under the revised system, the awards will be subject to review and could be reduced or withdrawn if doctors are found guilty of poor performance, outright failure or inappropriate conduct.

Numbers of consultants on the Committee on Distinction Awards will be reduced from 35 to 14. Eight of those seats will be for patient representatives and NHS employees.

The government is keen that consultants should not see the awards as a right, especially in light of the row over nurses' pay.

The awards cost the NHS �100m a year.

A consultant's basic pay ranges from �44,780 to �57,800. With a merit award, they can almost double this salary.

Figures for last September show that 12% of the 25,619 eligible consultants had been given the top distinction award.

A consultant who gains the distinction award receives a total annual salary of �112,710.

A consultant on the middle level gets �98,260, while one on the lowest award level gets �80,920.

Alan Milburn: Set to announce shake-up of pay structure

Mr Milburn said: "The government will make sure patients have a say when decisions are taken.

"The changes we are making will ensure the system is open and fair and go to doctors making the greatest contribution to patients."

He said consultants in some specialisms seemed to get more awards than others and women and people from ethnic minorities were "drastically underrepresented".

Unworkable

Tory health spokesman Alan Duncan criticised the proposal for patients to have a say in consultants' pay.

"How on earth can a patient compare consultants when they may only have been treated by one?

"This looks like a completely unworkable scheme. Even if the old system was bad, it needs a better solution than this. What does Alan Milburn think he is playing at?"

Critical

And some doctors have been critical. Winston Peters of the Hospital Consultants' Association said it is unfair to change an entire system because of the Bristol case.

"If you're going to hang a whole change in structure on one very distressing and tragic set of circumstances, you have to look at what would be good for the most. "Looking at one particular individual's package I don't think is how we should be looking at 25,000 consultants' packages."

Claire Rayner: the old system encouraged 'cronyism'

But health workers' union MSF and agony aunt Claire Rayner, spokeswoman for the Patients' Association, welcomed the move.

Ms Rayner called the old system "cronyism of the nastiest kind".

The British Medical Association also welcomed the review. But it said consultants did not regard the awards as a right.

"They are part of the consultants' remuneration scheme," said Dr Peter Hawker of the BMA.

Merit awards were instituted in 1948, soon after the NHS was set up. The aim was to top up doctors' pay and keep them on a competitive level with other professionals.