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Nurse leaders said the figures were 'staggering' and showed that GP practices were failing to reward nurses for the leading role they play in generating QOF income. GP profit per partner rose 9.8 per cent to £110,004 in 2005/6, but the DoH figures show practice nurses' basic salary fell £2,217 to £21,118 in 2005/6.

Meanwhile, figures for 2006/7 — the second year of a DoH-imposed pay freeze on general practice — from accountants Ramsay Brown and Partners showed that practice profits had fallen 7 per cent. The firm predicts a similar drop in 2007/8.

BMA GP committee chair Dr Laurence Buckman denied practices had cut staff pay, but warned falling profits would limit staff pay rises. However, he warned it would be short sighted to lay off staff.

RCN head of employment relations Josie Irwin said the 9.6 per cent fall in basic pay for practice nurses was 'shocking'. She said that average nurse pay across the board was around £25,000 and practice nurses should expect at least that amount.

She also pointed out that the age profile and experience of practice nurses was generally high, and that they should expect more pay. 'Some GPs, based on these figures, clearly are not passing on what they earned from the QOF to practice nurses,' she said.

RCN Practice Nurse Association chair Kate Howie said: 'I'm dismayed that in the year GPs had a big pay hike, practice nurse pay fell by 9.6 per cent — that is staggering.'

She was concerned that practice nurse pay would drop further, and warned: 'GPs not getting a rise in their contract is no excuse for not remunerating their staff properly.'