By politics.co.uk staff
Top-level NHS consultants can exploit a loophole which allows them up to £75,000 of bonus payments, regardless of the quality of their work.
Of NHS doctors, 36,000 consultants are eligible for the bonuses - on top of their £89,400 salary.
Although the size of bonuses, of which there are 16 greadations, theoretically depends on performance, a loophole means that bonuses cannot be taken away from poorly performing doctors.
At a time when every inch of public spending is being scrutinised for the spending review, the bonuses, which are a holdover from contracts dating back to the creation of the Health Service, are facing increasing calls to be scrapped.
The payments reportedly cost the NHS £200 million pounds last year.
Doctors have responded to the news with arguments reminiscent of those about the emotive issue of bankers' bonuses, saying the bonuses encourage professionalism and better performance.
Dr Paul Flynn, of the British Medical Association, said to the BBC: "It is only right that those who go over and above what is expected and do the best job get their performance rewarded."
However, it has emerged that the appraisals which determine the payouts effectively have little impact, as the loophole of the pay protection clause constitutes a 'life bonus'.
The bonuses are rarely if ever withdrawn. Even when they are, the clause means doctors can still receive the payouts.