Campaigners want to see a revamped merit award system for senior doctors which would place greater emphasis on discretionary awards at local level.

Action to clean up the merit award system, which gives high ranking consultants annual bonuses of between 23,000 and 56,000 until they retire, was announced this week by health minister Alan Milburn.

The plans include slimming down the Advisory Committee on Distinction Awards and including patients' representatives for the first time.

The ACDA will gain the ability to 'review and if appropriate, withdraw' awards. It will also have to ensure 'fair representation of women and ethnic minorities' when the 185m a year merit award pot is shared out.

'We would like to see more emphasis on discretionary awards at local level and not just the big awards,' said Sri Venugopal, president of the Overseas Doctors Association, which represents more than 40,000 overseas qualified doctors.

'Health authorities and trusts will receive new guidance on these proposals. We hope they will implement them.'

'This is great news for patients and women and ethnic minority consultants who have committed their lives to the NHS,' said Sam Everington, vice- chair of the Medical Practitioners Union, who has carried out extensive research on discrimination in the NHS.

Managers have also welcomed the changes, which will ensure employers have a say in all award nominations. Andrew Foster, chair of the NHS Confederation's human resources committee, said: 'Keeping the doctors we have in the NHS is absolutely vital. More open systems of reward will be of enormous help.'

But Peter Hawker, joint deputy chair of the British Medical Association's consultants' committee, said: 'Contrary to what ministers have said, distinction awards are not regarded as a right by consultants, nor are they bonus payments. They are part of the consultants' remuneration scheme and we will be discussing how to ensure that the money available is fairly distributed.'