They warned that many nurses are putting their registration at risk by taking on quality target work without the necessary training and supervision, because they fear the sack if they refuse.
RCN Practice Nurse Association chairwoman Kate Howie said: 'It takes a strong nurse to say "I'm not going to do that unless you train me to do it". There is always a fear that the GP practice will find someone else who will.'
She called on nurses to 'wake up' to the risks: 'If something goes wrong and you haven't had the proper training, you put patients at risk.'
GP practices earned around £120,000 each on average from quality points in 2006/7.
Research by charity Education for Health last month found that half of nurses delivering advanced COPD care, and a fifth of those delivering advanced asthma care, had no accredited training.
Many also reported that GPs were not available for second opinions when required.
Dr Richard Vautrey, GPC negotiator, said that nurses were right to raise concerns if they were being asked to carry out work beyond their competency.
'This isn't a concern that we were aware of and I think practices have reacted well to the quality framework in terms of supplying the right training. Where that hasn't happened it is right for an employee to make their concerns known,' he said.
'At the same time nurses have to work within the boundaries of their contract but I would hope that any situation doesn't become one of conflict,' he said.
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