Consultants working for the NHS are being paid large bonuses even if the quality of their work deteriorates, according to reports.
In a scheme which is now being reviewed, the top doctors in England are given the awards on top of their basic pay of £89,400, the BBC said, with a loophole in the system meaning they receive the bonuses for life.
It claimed half of the 36,000 consultants in England received the awards, with some getting more than £75,000 a year as a bonus. Similar schemes are in place in other parts of the UK with a smaller number of consultants paid the bonuses.
A total of £200m was given out in England last year under the scheme, with 19,892 people eligible to receive the payouts.
BBC News Online reported that consultants nominate themselves for the awards, providing details of excellence in their work. They are meant to be reassessed every five years but a Government review by the Advisory Committee on Clinical Excellence Awards, which oversees the bonus scheme, said this did not always happen.
Between 2006 and 2009, only seven of the top awards, each worth more than £35,484, were withdrawn. Doctors who have not been reassessed were contacted by the committee this year but continue to get the money, even though the awards have been withdrawn, because of a pay protection clause.
The system is being reviewed by the independent Doctors' and Dentists' Review Body, which is due to report next year, amidst calls for it to be scrapped.
A Department of Health spokeswoman said: "Anomalies like this are exactly why the Secretary of State announced a review into these awards."
The scheme dates back to 1948, the year of the NHS's birth, and has been defended as being a fair system, designed to motivate consultants.
Dr Paul Flynn, of the British Medical Association, told the BBC: "It is an integral part of the pay structure for consultants. It is only right that those who go over and above what is expected and do the best job get their performance rewarded."