The health system not always aligns with the intrinsic drive of GPs to provide good patient care. For transformation to a future health system that better aligns, collective action is needed. Taking the liberty to initiate bottom-up change may provide a health system that allows for better patient care and being proud of one’s profession. How GPs contribute to system change is not widely understood.This study examines GPs’ perceptions on how they contribute to collective change in the health system. With a better understanding of the environment in which GPs contribute to change, we might be better equipped to aid (future) GPs in contributing to health system change.Using purposeful sampling, we conducted individual interviews with thirteen GPs who contributed to change in the health system. Using the Rich Picture method, GPs first drew a situation in which they contributed to change in the health system. The use of a Rich Picture allowed for deeper reflection. Next, they elaborated on the environment where their contributions to change took place. We used an inductive and deductive thematic analysis informed by Cultural Historical Activity Theory, looking at the health system as closely linked environments that GPs work in.Most GPs became involved in changes in the health system because of tensions between the closely linked environments, that limited them in providing good patient care or being proud of their profession. Individual initiatives evolved into collective actions for structural change by making tensions debatable and urgent. Often someone helped them recognize the possibility of questioning long-standing practises and taking action. Current GP training in the Netherlands was perceived to be less important for becoming change agents.This research shows how GPs initiate health system change by questioning long standing practices and co-constructing a new practice. GP training could do more to prepare (future) GPs for contributing to health system change.Enabling GPs to contribute to health system change allows for improved patient care and proud professionals. Postgraduate training and continuing professional development that stimulate questioning current practices and make GPs’ potential for change visible, may enable GPs.