Hospital consultants who fail to meet new quality measures could have their merit awards withdrawn by the Commission for Health Improvement.
Health minister Alan Milburn said last week he had asked distinction awards advisory committee chair Sir William Reid and medical director Christopher Paine to report on ways to make the system fairer and more representative.
The initiative follows criticism that the present system discriminates against consultants from ethnic minorities and those in rural areas. But the Bristol baby deaths case has also focused ministerial minds on more immediate concerns.
James Wisheart, the Bristol Royal Infirmary consultant heart surgeon, who this week returned to face the General Medical Council, won his A- plus merit award in 1994 when serious concerns were voiced about his work. He continued to receive the award - worth more than pounds50,000 a year on top of his NHS salary - until retirement, when it would have been consolidated into his pension.
After speaking at the British Association of Medical Managers conference last week, Mr Milburn was asked whether recommendations on merit awards should figure in the CHI's remit.
He told HSJ he would look at the committee's proposals, 'but that is all I can say for the moment'. He did 'not know yet' if CHI would get the power to withdraw merit awards.
Medical Practitioners Union vice-chair Sam Everington, a vociferous opponent of the merit award scheme, welcomed the review, and urged that it should be brought within CHI's remit.
He said: 'The way forward is to make them a quality issue, to be awarded for services to patients. The awards must be given to those who have made a commitment to the NHS.'
A Department of Health spokesperson confirmed that a shake-up of the award system was likely before the end of the year.