Doctors' leaders have warned targets are putting excessive pressure on medics and resulting in bad decisions for patients, and called for an end to their use in Scotland's NHS.

Peter Bennie, chairman of the British Medical Association's Scottish Council, claimed healthcare targets contribute to a blame culture and do not always focus on the patient's best interest.

He gave the example of patients being moved from A&E wards to meet a four-hour waiting time target, with such moves viewed as a success even if the patient ended up on an inappropriate ward.

The doctors' union chief called for a "fundamental" shift towards allowing staff to use their own skills and judgement.

While paying tribute to staff working over the festive period – who he said were providing a first-class service – Dr Bennie said there was a place for timescales in which a patient should expect to be treated or discharged. But he said these should not be the main or only way of judging the performance of Scotland's NHS.

He added: "Against a background of insufficient funding, increasing vacancies and rising demand, the expectation put on hard-pressed doctors and the whole healthcare workforce to meet the various targets currently in place is simply not sustainable."

Multiple targets, combined with an ageing population and a lack of resources are creating a "vicious circle" he said, stretching NHS staff and the system itself to breaking point.

Dr Bennie said: "The current culture of using crude measures, often taken in isolation, to judge the complexities of the whole healthcare system, and to apportion blame, must end.

"I believe that there will always be a need to set standards for patient care, and for these to be monitored. Proper use of these figures can provide indications of where improvements in funding or service design are needed, and where the system is under most pressure.

"However, saying that a patient moved out of A&E, perhaps to an inappropriate ward, simply to meet the four hour target, is somehow a success, when it may well have been better for the patient to stay in the emergency department, indicates the faults with the current over-reliance on targets and the pressure they place on healthcare staff."

A more mature approach would be to emphasise doing the right things for patients and trust healthcare staff to make decisions about care, he said. "We must focus more on whether we have delivered the best possible care for [people], not simply how long they wait to get treated."

An Audit Scotland report on the NHS in October found seven out of eight of the targets set by the Scottish Government – including the four-hour A&E target and a target for the time people should wait for treatment after a cancer diagnosis – had been missed, for the second time in a row.

Earlier this year Scotland's chief medical officer Dr Catherine Calderwood used her annual report to press for more use of "realistic medicine", with the ambition to put patients at the heart of decisions about their care, while reducing unnecessary treatment and waste.

Health Secretary Shona Robison said treatment targets had a place as part of a "balanced" approach to managing the NHS.

She said: "Targets and indicators form part of this balanced approach and have an important role in giving people clarity on what to expect from health and social care services, and in monitoring performance across the country. But they can never be an end in themselves."

She added: "Our ambition must be to not only improve the care of individuals needing treatment, but to utilise the information from improved systems to enhance the health of Scotland as a whole."

Scottish Labour health spokesman Anas Anwar said NHS staff are over-worked, under-valued and under-resourced."Standards are important, but it is essential the NHS and wider care sector has the resources they need to realistically meet those standards and deliver the quality of care that patients require.

"Labour has already established a workforce commission to tackle the SNP's staffing crisis in our NHS - and we would use the powers of the Scottish Parliament to invest in our health and care services."