Saul Miller is a GP in Wooler, Northumberland.
Picture the scene: an ill-maintained flat-roofed building built cheaply when post-war austerity still held sway over planning decisions; surrounded by housing of the same era now adorned with the trappings of the socially deprived — unkempt gardens with abandoned equipment and failed fences, vehicles parked around that may or may not be roadworthy.
Zoom in, through the sticky-backed plastic that renders all the windows dully translucent but no longer transparent: this will take imagination, of course.
And in that room at the end of the linoleum corridor, you will find the two of us.
“We can’t strike because we work for ourselves legally though in reality almost entirely for the NHS.”
This is a consulting room, of course — the idea of a room set aside for meetings had not reached the collective imagination of those who penned the rules back when the building was designed, those rules published as the ‘Red Book’.1 But it’s our biggest one and we take turns as to who gets the big chair.
‘So,’ Dev says, returning us to the agenda item we had momentarily digressed from, ‘what’s our position on collective action, Bev?’2
I pause, picking at my teeth. ‘It feels to me we continue to suffer the problem of being self-employed while still also seeing it as a benefit. We can’t strike because we work for ourselves legally though in reality almost entirely for the NHS. Much as we would like to strike, not being directly employed by the NHS has helped give us some extra room for manoeuvre in the past.’
Dev nods. ‘And helped us earn a reputation for being as herdable as cats. Anyway, the collective action is thus marginal, isn’t it? It falls a long way short of a punch on the nose.’
‘More of a tickle’, I laugh.
Dev leans back in the consulting room chair, its faux leather creaking slightly. He studies the damp-stained polystyrene ceiling tiles. ‘That it has come to this,’ he sighs, ‘the government can impose a contract at will and we have to be so careful not to breach its terms even whilst being in dispute about it.’
‘So leaving the NHS is the only other option then?’ Moving uncomfortably in the hard plastic patient chair, I make it a question.3
Dev gives a soft laugh. ‘Ah yes, the dentists’model — patients pay a private subscription to access oral care. I think we both know it has turned this area into a dental desert. How often do we advise seeing a dentist when realistically …’ He tails off.
‘Carry on doing what we can and hope relief will come some time before the roof or the NHS itself collapses?’
There is silence for a moment as we consider how an area like this would not sustain even a single GP if it needed private subscribers, almost regardless of the level set for those costs. Creating an equitable distribution of GPs was an NHS aim from its inception but the mechanism for that was abandoned in 2001, causing things to deteriorate already.4 But this would completely undo those 53 years of positive effort.
I look across at Dev. ‘My mother says the promise of the NHS was the deciding factor in persuading them to come when they could have got work in other countries instead — she still maintains the release from needing to worry about how you will afford it if your health fails is one of the greatest achievements of this country.’
Dev raises his eyebrows. ‘I have honestly never thought of it that way,’ he says, ‘but she has a point.’
We both stand up, somehow relieved to have come back to the same place again.
‘Carry on doing what we can and hope relief will come some time before the roof or the NHS itself collapses?’ I summarise.
‘The promise has frayed, Bev,’ Dev responds cheerfully, ‘but threadbare it survives.’
References
1. Rosen R. A short history of the GP contract and its evolution in England. 2025. https://www.nuffieldtrust.org.uk/news-item/a-short-history-of-the-gp-contract-and-its-evolution-in-england (accessed 21 Aug 2026).
2. British Medical Association. How to take part in GP collective action in England. 2026. https://www.bma.org.uk/our-campaigns/gp-campaigns/england/how-to-take-part-in-gp-collective-action-in-england (accessed 21 Aug 2026).
3. Colivicchi A. UK GP leaders vote to explore ‘dentist’ model ‘outside the NHS’. 2026. https://www.pulsetoday.co.uk/news/lmcsconferences/uk-gp-leaders-vote-to-explore-dentist-model-outside-the-nhs (accessed 21 Aug 2026).
4. Gooderham J. Equitable distribution of general practitioners in England. 2021. https://committees.parliament.uk/writtenevidence/40978/pdf (accessed 21 Aug 2026).
Featured photo by Francesco Ungaro on Unsplash.
