TARGETS have become a ubiquitous part of the modern NHS in everything from waiting times to immunisation rates.

They are designed to be benchmarks against which performance can be measured and improved, and have been credited in the past for driving down waiting times for operations and vital tests like cancer checks, but they have also blamed targets for distorting clinical priorities.

Healthcare think tank, the King's Fund, concluded that while targets in the English NHS "appear to have been successful in improving aspects of NHS performance, particularly in relation to waiting times" there was also worrying evidence of "unintended consequences – for example, distortion of priorities or neglect of other non-targeted activities". Another think tank, Nuffield Trust, found evidence of negative fallout such as managers being more likely to be "named and shamed" or sacked, bullying and a spike in 'gaming' - the wilful manipulation of data to make performance appear better than it is in reality.

This is worth considering since a review of NHS targets is currently underway, chaired by former Chief Medical Officer Sir Harry Burns, and expected to be published imminently.

Among the areas up for review is the four-hour A&E target, which has arguably become a bellwether for overall NHS performance. Weekly performance statistics make emergency departments the most scrutinised area of the NHS, yet nearly every week since March 2015 the target has been missed. The Queen Elizabeth University Hospital in Glasgow recently recorded its worst ever performance at the end of April.

Sources indicate that there is no plan to scrap or downgrade the four-hour target; the idea is not "politically palatable" since it would gift rivals a chance to accuse the SNP of copping out, and would draw undesirable comparisons with Tory policy in England where it was scrapped in January for all but urgent cases.

But that does not mean that such as move would not have its supporters within the medical profession in Scotland. There is detailed evidence showing that the four-hour A&E target, introduced in 2006, has sucked money into hospitals at the expense of general practice. While hospitals massively increased the numbers of emergency consultants and a whole new breed of consultant - acute physicians - has been created to staff the Acute Assessment Units which sit alongside A&E, between 2006 and 2013 the share of funding for general practice in Scotland fell by 17.6 per cent. With district nurse numbers also falling and a council tax freeze squeezing cash for social care, it is no surprise that A&E admissions soared 25 per cent over that same period. And when did four-hour compliance fail?: whenever large numbers of very old people turned up at A&E. Significantly, the rate of ageing among A&E attendees increasing two to three times faster than the general population, suggesting something has gone very wrong in home and community care.

No one wants long waits in A&E, but perhaps it is time to consider whether this target has distorted priorities?