The practice of neurology has changed in the 63 years since a national health service was established in the UK. In 1948, the sun was already setting on a golden age of descriptive British neurology that had lasted for almost 100 years. Neurology had acquired a fine reputation for hagiography and self-referential eponymous classification. Famous figures were remembered by diseases named after them although most of these designations attracted rival claims for priority in giving the first account of that disease. Clever diagnoses were made, but nothing much could be done about them. Outside London, a few hospitals were staffed by a single-handed consultant who took responsibility for vast swathes of the countryside. The rest took their chance with non-specialists. The provision of services focused on shifting huge numbers of cases in record time and led to the caricature of neurology: ‘you have a brain tumour; I’ll write to your doctor’. When experimental medicine gathered pace in the 1960s, and new disciplines impacted on the understanding of disease mechanisms, neurology was slow to engage with the modern era. Training remained centred on London. Advancement was unpredictable, maverick, patrician, openended and dependent on dead-men’s shoes. There is no doubt that many of the NHS reforms of the early 1990s, and related changes, altered neurology in a way that benefited patients and transformed the specialty. The gross under-provision of neurological services throughout the UK was exposed; and a workable mechanism provided for rapid and substantial manpower expansion. The internal market and imposition of shorter waiting times led directly to services being provided closer to the onset of symptoms and nearer to home. A substantial increase followed in the number of consultant neurologists. Membership of the Association of British Neurologists increased from 194 in 1970 to 1,116 in 2011. The revision of training structures providing curriculum, mentorship, assessment and a timescale for apprenticeship complemented these changes. To some extent, increased provision encouraged a fall in the threshold for referral fuelled by ‘fear of neurology’ among non-specialist medical practitioners. The ‘worried well’ could now be passed on to neurologists more easily, rather than having to accept reassurance from primary care and general physicians. Neither the culture of litigation and complaints nor the steady erosion of neurology in the undergraduate curriculum of medical schools did much to enhance neurological confidence among non-specialists. Manpower expansion and the principle that people with neurological disease should be seen by specialists early in the course of their illness and at a convenient time and location have encouraged the development of sub-specialism. This is appropriate; and patients have also been much advantaged by the appointment of specialist nurses whose work, often disease specific, provides ready contact, approachability, a style that not every neurologist can match and which patients value, and much better management of the many practicalities needed to assist aspects of daily living in the context of chronic neurological disability. With funding increasingly allocated to research and development through the structures of the National Institute of Health Research, the need and opportunity to advance understanding of neurological disease and improve outcomes have come ever more sharply into focus. As always, it