Published: 01/09/2005, Volume II5, No. 5971 Page 9

Patricia Hewitt and her team of ministers at the Department of Health seem to have made the best of the August break, with just one of them on rota duty, sometimes from home, during much of the month.

Good for them. We should all take our holidays and, if the mad hours which junior doctors used to endure were wrong ('I once had three hours' sleep in two days, ' a chum recalled on our holiday this year), they were also wrong for politicians. Tests done years ago proved ministers took bad decisions on tired Fridays.

But the Scots take their annual holidays earlier to catch the better weather ('brilliant on the summer isles in July, ' reports a Highland colleague) and they get back to political squabbling a couple of weeks earlier too.

Thus Scottish health minister Andy Kerr could be heard the other day defending the depressing news that one in 50 operations in Scotland is still cancelled, around 13,000 a year, though I was pleased to see the Scottish National Party suggesting that more English-style specialist units run by the private sector could help cure the problem.

It has been difficult for both Scotland and Wales to make the right choices about public service reform. They have not even tried yet in Northern Ireland because the Troubles dominated everything.

There is a sense of Celtic solidarity, socialist or not, which despises what they see as the selfish materialism of England. But by insisting on what Welsh first minister Rhodri Morgan likes to call 'clear red water' they have seen their own healthcare services, better funded in Scotland too, fall behind.

Pressure from London has mounted.

Coincidentally a family friend from the Old Commonwealth, a GP with a large rural practice at home, stayed with us the other day and talked about her experience working for six months in a group practice in urban Scotland.

For one thing it took a huge effort to get registered at all in the UK despite having been a doctor for 20 years, delivering an average 70 babies a year etc etc. A three-hour multiplechoice exam, video-assessment, even an English language test, although that was obviously a fairness point to avoid offending Indian or African applicants.

Three things struck our friend most forcefully. One was the overcentralisation of the service, which slows everything down - and in doing so enables many patients time to get cured anyway. Not the unlucky ones, of which there are still too many in Scotland, as Robin Cook discovered.

But she was also struck by the passivity of the patients in response to long delays or lost files. She recalled a man having to be off work for five weeks waiting for physiotherapy. Daft! X-ray delays were a huge bugbear too.

It would not happen at home, not least because patients have to make a modest contribution via the excellent health insurance systems.

Let's not reopen that issue again, but it does mean a GP has to earn his/ her salary from paying customers, not just tick the boxes on the new contract, notes our friend.

The other difference that bothered her most was organisational, not cultural: the feeling that GPs here are becoming 'de-skilled through lack of practice', that too much is referred to outpatients too soon, adding to delays and inefficiencies.

Thus a GP might not see a new baby again for a year or two. 'The concept of family practice seems to be dissolving here, ' our Commonwealth friend suggests, recalling the pleasure in seeing a child from cradle to adulthood.

I can hear you muttering that England is different and that on both sides of the border the trend is towards GP empowerment, not deskilling. Yet Tory MP Andrew Selous, who sits for Bedfordshire South West - as English as you can get - staged a Commons debate about family doctor services a few weeks ago and expressed a range of worrying concerns.

They included out-of-hours cover and the familiar battle between practices for funds to build new premises at a time of rising deficits.

Public health minister Caroline Flint sought to stress unprecedented levels of investment in primary care, the growth in GP services and specialisms, not to mention pay. All good stuff and change is necessary.

But you do not have to be Scottish to be nervous. .

Michael White is political editor of The Guardian.