The government risks damaging the relationship between doctors and patients if it pushes ahead with “unethical” performance-related pay, a union has warned.

The British Medical Association said ministers must rethink plans to pay GP consortia a bonus for managing their finances well.

The BMA has launched guidance for groups of GPs who have already formed into consortia on how to ensure transparency, honesty and decency.

The guidance - Ensuring Transparency and Probity - sets out how GPs will now be in the position of providing care as well as making decisions over where that care takes place.

It is “absolutely vital that the public, patients, other doctors and health professionals have the utmost confidence and trust that the commissioning decisions of GP consortia will be solely in the interests of patients, and with no actual or perceived vested interests or motives,” it says.

The document says the trust patients place in GPs is the “cornerstone of general practice” and must be maintained.

“Where GPs are both providing care and deciding where that care takes place, how it is provided and who provides it, there is a real risk that a doctor’s probity may come into question.”

GPs who have a financial interest in the company where they are referring patients for treatment must tell the patient of this fact, the document says.

GPs with a 5 per cent or more financial interest in a provider must also not sit on a consortium management board if a contract with the provider exists, or if there is likely to be one in the future.

Registers of GP interests should also be set up to ensure transparency.

If performance-related pay awards are introduced, they should not become funds for individual GPs, the guidance says.

“Incentive schemes, if they are introduced against our advice, should only generate awards for consortia to spend on patient care via consortium activity NOT become funds for individual GPs or practices.

“We do not believe it is ethical for practices to receive payments that arise in any way from diminishing patients’ services.”