It was a different matter four years ago. Patients in England were becoming "healthcare consumers" who could, in theory, choose where to go for treatment from a number of places, including private clinics. In contrast, Scotland seemed to be sticking to the system people knew: health service care, ideally in their local area.

It was a different matter four years ago. Patients in England were becoming "healthcare consumers" who could, in theory, choose where to go for treatment from a number of places, including private clinics. In contrast, Scotland seemed to be sticking to the system people knew: health service care, ideally in their local area.

Malcolm Chisholm, the then Health Minister, was applauded for resisting such controversial Westminster initiatives as foundation hospitals. Now, however, opinion is split on whether the English policy of increasingly using the private sector to treat NHS patients is seeping north of the border.

Examples include the regional treatment centre in Stracathro, Tayside. Opened by First Minister Jack McConnell this year, it is run by Amicus Healthcare, part of Netcare - one of the largest private-hospital operators in the world.

Some 8000 procedures, such as hip replacements, are expected to be carried out there in the next three years. A number of health boards have also brought in mobile treatment centres, run by private firms, for specific operations, and another multi-national, Serco, recently tried and failed to take over a GP practice in Lanarkshire.

Professor Allyson Pollock, of the Centre for International Public Health Policy at Edinburgh University, believes Scotland's politicians should have consulted on this "major change in service". She says: "We know the sector in England has been critical of what poor value for money independent sector treatment centres (ISTCs) are and how they are destabilising the NHS. The policy has been a disaster, yet it is now being imported to Scotland."

A House of Commons select committee report on ISTCs backed concerns that they could affect the viability of NHS services and did not help train tomorrow's doctors. Professor Pollock says: "This is a big issue for the public sector in Scotland. Can the devolved nation forge its own destiny? This is a cry for independent thinking."

Private finance initiatives - where consortiums fund and construct public-sector buildings, then lease them back to the state - have raised hackles. But the British Medical Association, which regularly attacks the London administration for its "infatuation" with the private sector, is more sanguine in Scotland.

Dr Peter Terry, chairman of the BMA in Scotland, says he does not see creeping centralisation north of the border. "There might be some short-term initiatives which we are prepared to support to try to help waiting times and waiting lists," he says. "We see that as appropriate."

He describes the Stracathro ISTC as "an experiment" and is willing to sit back and analyse what benefits it provides. However, he notes: "From what we see in England, they are doing nothing but destroying the health service."

Investing in the NHS and building its capacity is still his top priority.