Health minister John Hutton has rejected doctors' claims that government targets are compromising patient care.

A British Medical Association report released on Monday argued that accident and emergency targets of treating and discharging patients within four hours put pressure on hospital staff to cut corners and led to bullying by health trust managers.

The BMA poll of A&E consultants from 163 hospitals in England found that staff felt patients were being discharged too soon or admitted inappropriately in order to meet the goal.

"It is absolutely right that patients visiting A&E are seen and treated as quickly as possible but not if staff are being forced to make inappropriate decisions and patient care is any way compromised," BMA A&E committee chairman Donald MacKechnie said.

But Hutton said the survey gave "a deliberately distorted picture" of reforms.

"We know there is further to go, but A&E is now unrecognisable from what it was just a few years ago," he said.

"If any doctors have genuine concerns about patient care or fiddling of figures, they have a clinical duty to take them up with their medical director or chief executive, or - failing that - with their strategic health authority or the Department of Health.

"To date we have received no formal complaints. If we were to receive specific concerns, we would investigate them immediately."

And Sir George Alberti, the government's emergency access "tsar", said: "This BMA survey is not representative of all A&E staff who are proud to be offering faster and better services to patients.

"The four-hour target is there to improve patient care. We are not putting any pressure on hospitals to set clinical priorities aside - quite the reverse.

"Treatment of patients in an inappropriate way is never acceptable and clinical priorities must always override all other considerations."

PM's concern

However the prime minister conceded on Sunday that NHS targets may be impeding clinical care.

Interviewed on ITV's Jonathan Dimbleby programme, Tony Blair promised to look again at directives on waiting times that doctors have complained are distorting patient priorities.

He defended the government's use of goals to ensure more cases are dealt with more quickly, as a means of ensuring value for taxpayers' money.

"I have put an extra one pence on National Insurance and put people's taxes up to put record amounts of money into the health service," he said.

"What we believe is that we also have to show the public there are outputs to this.

"However I think what we do need to do is to make sure those targets don't actually conflate with the quality of care.

"I agree with that and that is something we need to sit down and work out with you."

Pressed by one hospital doctor on the controversial maximum four hour waiting time in A&E, Blair acknowledged the concern.

"There are real issues as to how these targets are used. I understand what people say about the four hour one in accident and emergency," he said.

"It is very difficult this because if you went back a few years ago, accident and emergency departments were a pretty ghastly place to be.

"People used to wait an awful long time for something pretty simple in it. I think most people would say the accident and emergency departments are a lot better than they were.

"Now we feel, maybe we are wrong, but we feel that one way we have managed to do that is by setting a clear target. But I agree maybe we need to look at how we have sufficient flexibility in the targets."