Top hospital doctors face the loss of distinction awards worth up to £56,000 a year if the conduct of their personal or professional lives 'undermines confidence' in the system, guidance issued to the NHS this week confirms.

New rules set out by the Advisory Committee on Distinction Awards in the wake of the Bristol babies' heart surgery scandal specifically cite General Medical Council findings as one issue which might bring an award into question.

Other factors could include criminal convictions, disciplinary action by an employer and 'in due course, Commission for Health Improvement findings'.

The move follows a promise by health secretary Frank Dobson in the wake of the GMC hearing into the Bristol case that he would try to find a way to claw back the band A merit award of discredited consultant surgeon James Wisheart.

In its guide to the scheme, the committee says: 'From 1999 ACDA will have the option to review the award of any consultant at any time and, if appropriate, to withdraw it.'

A spokesperson for the British Medical Association said it 'certainly did not oppose the principle' of reviewing awards, but that the BMA was 'looking for a certain amount of rigour about the way it is done'.

She added: 'We will be in talks with the Department of Health about the detailed mechanics of how the process should be carried out because it does affect doctors' terms and conditions.'

Other changes to the distinction awards system for next year are aimed at countering criticisms that it discriminates against black and ethnic minority doctors, and those working in 'unfashionable' specialties.

For the first time, consultants will be able to nominate themselves for an award and have their name 'considered on an equal basis with those nominated by other routes'.

A further reform will ensure that the case of any consultant who has not been granted an award within 10 years, or whose award has not been upgraded, will be given 'special consideration' to ensure that they are not being 'overlooked'.

ACDA chair Sir William Reid said he and medical director Sir Christopher Paine were 'determined to ensure transparency and openness within the distinction awards scheme'.

Launching the guide, the most detailed ever issued, he said: 'All consultants, especially those who wish to be considered for an award, and others with an interest in the scheme, would do well to read it.'

The NHS Confederation was unable to comment on the guide. A spokesperson said no one had read it.

Guide to the NHS Consultants' Distinction Awards Scheme: 1999 awards round. HSC 1998/187. www.open.gov.uk/doh/

nhsexec/acda.htm