Dr JAF Napier of the Welsh Blood Service, who confuses income and salary (Letters, 24 September), urges that I be burnt at the stake for suggesting half of all consultants earn more than the average of £100,000. It is, of course, possible that the private practice gravy-train slows significantly after the Severn bridge, and distribution of income is highly skewed. This is evident from the figures published by the independent sector.

Distinction awards also contribute to the skew, to a lesser extent. The annual report of the Advisory Committee on Distinction Awards - which is charged with administering this 50-year old sop to the medical profession - makes fascinating, albeit disturbing, reading. These glittering prizes are bestowed on around one in eight consultants. In 1997, 267 received an A+ award, 920 an A and 2,042 a B. Ministers have already questioned why white consultants are three times more likely to be recognised than those from ethnic minorities. There is also a pronounced gender bias, even though the committee derives smug satisfaction from the fact that women received an increased proportion of new awards - but why 14.4 per cent is comforting when one in five consultants are women is mystifying.

The awards' actual value beggars belief. Well conceived performance-based payment systems do not reward such a small proportion of the workforce in such a distorted manner. Why should 267 consultants receive over£50,000 extra a year forever, 920 close on£40,000, 2,042 near to£22,000 and the rest nothing? Such a lumpy system cannot possibly be based on any rational assessment of the value of the performance supposedly being judged distinctive, and is bound to be divisive.

The nomination system itself smacks of the old boys' network. Given that nominations for awards are sought from existing A+ holders, little wonder that perceived outstanding performance is consequently distributed so unevenly among specialties. Can one really accept that 42 per cent of immunopathologists deserve an award but only 12 per cent of obstetricians?

Particularly depressing is the 1997 report's implication that distinction awards are not intended as a measure of the quality of patients' treatment. Doubtless the Bristol parents will secure no satisfaction from this disclaimer, which borders on the obscene.

By common consent, committee chair Sir William Reid was an effective ombudsman. He would go down as an exceptional chair of this slightly absurd body were he to succeed in dismantling it, thereby removing a contentious payment mechanism.