Tony Blair has rejected claims that government targets on NHS waiting times and lists are undermining patient care.

The prime minister was speaking after Iain Duncan Smith raised the case of a senior orthopaedic surgeon, Martin Bircher, who said hospital managers ordered him to stop treating emergency patients from outside his local area and focus on routine operations in an effort to cut waiting lists.

The Conservative leader said the government's targets were undermining the principle of care based on clinical need.

"It's not an isolated case," he said. "The National Audit Office in its own report said they found over half of all consultants said that clinical priorities are taking second place to government targets."

"Shouldn't he now take action to get the administrators and his own government ministers out of this process and stop setting those targets, and let doctors take over again," said Duncan Smith.

But Blair hit back, saying the Bircher's claims were being investigated.

"What he just said...is absolutely extraordinary, that we should scrap any of the waiting list targets or waiting time targets.

"He shakes his head, that's what he just said, I heard him say it. I know he's a quiet man but I heard that," jibed Blair.

"Of course we must make sure that clinical need comes first but I have no intention of getting rid of targets to reduce waiting times and waiting lists because it is important to patients."

"The problem that many people face is a problem of access into the health service. They wait too long for their operation, they wait too long to see their GP, they wait too long in Accident and Emergency," said the prime minister.

"And if he's saying now that if he is not merely against the money going into the health service - that we knew - but he is also against the reform of the National Health Service then I suggest he gets quieter still."