Government discontent with the system of distinction awards paid to British consultants surfaced this week in a package of measures that the Department of Health described as the biggest reform of consultants' pay for 50 years, with a more fundamental review to follow next year.

Although issued for consultation, the proposals reflect already firm government policy, which will influence the 1999 doctors' pay review. Under these proposals, the Advisory Committee on Distinction Awards, which currently comprises 33 members (including 25 consultants), would be reduced to 14--a chairman, five consultants, and eight representatives of NHS employers and patients' interests.

The new committee would be able to …