West Hertfordshire Hospitals NHS Trust has denied claims its redevelopment plans are in "crisis".
The New Hospital Campaign Group (NHC) has accused the trust of having no "clear idea" of the way forward and echoed calls for a hospital to be built on a new site away from Watford.
The trust recently received permission to rebuild Watford General next to its current site and is waiting for confirmation of funding from the Government.
The NHC has criticised a decision to keep the main hospital facilities, including emergency care, in Watford, because of concerns about how easily accessible the "crowded" site is to the rest of west Hertfordshire.
The group also believes patient care will be disrupted while the new hospital is built and campaign co-ordinator Philip Aylett claims the trust is in "crisis" after even "rejecting" its own approved plans.
Trust deputy chief executive Helen Brown denied this saying: "We have reduced the height of our planned buildings in line with suggestions from Watford Borough Council’s planning officers....aside from this adjustment our designs remain very much as we set out in our outline planning application."
The trust added it is unsure where 'crisis' claims have come from.
Related: Call for funding commitment for Watford hospital redevelopment plans
A recognised stall in developing the plans has prompted the NHC and Hemel Hempstead MP Sir Mike Penning to speak up about building on a new site.
Mr Penning said it is "bonkers" the trust is "wasting this once-in-a-lifetime opportunity to patch-up Watford instead".
The Tory MP added: "The trust are worried if they change their mind they will be kicked out of the first group of new hospitals. To be honest, if that’s what it takes to get it right, then I say fine. A year or so delay would be worth it."
Meanwhile, Mr Aylett says there are a number of possibilities for out-of-town sites, including some that have been "wrongly rejected" by the trust already.
Ms Brown said looking again at new sites is "folly" and would put the trust's place as one of the first in the national New Hospital Programme "at risk."
She added: "It’s no secret our buildings are unfit for purpose, which is why we are backing an option we know can deliver. "Our chosen site was assessed independently alongside others. Quite simply, this location provides the best and fastest route to having new, better buildings.
"We have looked at alternative sites but finding enough land, in the right location and with the potential to accommodate a new emergency care hospital is no easy task and that’s before we even start grappling with the complex planning and infrastructure issues associated with a new site.
"To date, we have not identified such a site and we fail to see why waiting will suddenly make this easier. Starting this process all over again could add years to our programme or at worst, fail to come up with a solution."
The plans at Watford include a major new clinical block for the vast majority of emergency and specialist care services, including maternity and children’s services.
The trust also plans to invest in Hemel Hempstead and St Albans hospitals.
Ms Brown added: "We firmly believe retaining and redeveloping our three hospitals is the best and fastest route to the significant improvements to our hospitals that are urgently needed. Our proposals might not have the backing of campaigners but they are based on the input of our senior clinicians and they are well supported by our staff."
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