The average basic pay of a practice manager dropped by 0.87% for the first time last year, it is claimed.
First Practice Management's (FPM) survey of more than 1300 practice manager's salaries shows the average practice manager's income now stands at £38,758, compared to £39,059 in 2011 and £37,800 in 2010.
A 5% increase in the value of bonuses paid to practice managers last year means they have seen an overall reduction in their total average pay of 0.77%.
The Salary Index found Greater London has remained the top-paying region of the UK, with average total earnings of £42,263, a decline of 3% over 2011 figures.
More than half of practice mangers (58%) surveyed working in Greater London earn £40,000 or more, "significantly" down on 71% who reported the same in 2011.
The East region has overtaken the South East as the second highest paying region with an average overall pay of £40,863.
Wales now stands as the lowest paying region for practice managers, with an average pay of £33,906. Scotland and Northern Ireland – two regions that have traditionally been among the lowest paid – showed "significant increases" to £35,227 and £34,253 respectively.
"Many practices report a further year of frozen staff salaries, partially as a result of rising costs and the continued squeezing of central funding, but also reductions in local funding streams as primary care organisations look for cost-saving measures, especially in the removal of Local Enhanced Services," said Steve Morris, General Manager at FPM.
"At a time when activity levels in practices are stepping up as commissioning gathers pace, and CQC requirements impose greater demands on managers and staff, there is a view that both practice and personal rewards are inadequate.
"Managers are reporting dramatically increased workloads and responsibilities and this is especially evident in those practices where support structures have not yet evolved to meet the demands of the new era.
"There is also evidence from the survey that other practices have revised their structures to cope, splitting out elements such as IT and finance from the more traditional Practice Manager role to a new level of support management staff, allowing the manager to become more strategic than administrative."
For practices with less than 5000 patients, the average manager's income is now £31,589, 2% less than last year. Yet managers working in "very large" practices (more than 14000 patients) their average pay went up by 1.5% to £47,491.
The Salary Index also showed 3.75% of practice managers surveyed had Partner status in their practice – up slightly from 3.5% in 2011.