Primary care trusts could push for freedom to determine senior managers' pay as a reward for becoming world class commissioners.
The Department of Health is considering giving high performing PCTs freedoms similar to those given to foundation trusts.
PCT Network director David Stout said: "If you trust a PCT to spend millions of pounds on local healthcare it seems bizarre that you don't trust them to determine their own pay structures."
PCTs would be interested in freedoms and rewards around the use of capital, the relaxation of performance management and a seat at the policy table.
Speaking to the Commons health select committee last week about the world class commissioning framework, Mark Britnell, DH director general of commissioning and system management, said: "We are looking at what the sanctions and rewards might be.
"One of the things we are looking at are the freedoms that have been applied to foundation trusts and seeing if these are relevant to those who outperform on the framework."
He said that performance would be measured relatively, to ensure that more affluent areas with better health outcomes would not be advantaged over poorer areas.