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A tribute to the 9ers

Dr Shaba Nabi

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Once upon a time, I was a 9er.

I was a 9er through three pregnancies and extended breastfeeding. I would pop home at lunchtime, between visits, offer a quick feed, go back to work, and be home in time to give another two feeds before bathing my kids and putting them to bed.

I am no longer a 9er. Today, my kids are older, but I can barely manage four clinical sessions a week, let alone nine. On the day of the Pulse workload survey (see page 6) I worked a 14-hour day as I was on call followed by an evening LMC meeting. On the way home, I nearly crashed my car by driving down the wrong side of a dual carriageway.

My younger days of sleep deprivation don’t even come close to the degree of emotional exhaustion I now feel after a full day at the practice. It’s not just the length of the day that has increased; the sheer intensity and emotional labour of our work renders us incapable of anything else.

Core general practice is the only specialty where you don’t go home until your work is complete. The capitation model has chained us to infinite needs and demands of a patient, and these must be met before we exit the building. The result is conveyer-belt medicine: multiple decisions, treatments and management plans occurring every few minutes for the better part of 12 hours. It is not unusual to have up to 80 patient contacts a day, 40 letters to read, 30 scripts to sign and 20 blood results to file.

After a 14-hour day, I almost crashed by driving the wrong way on a dual carriageway

The term ‘decision fatigue’ has been used to describe the diminishing quality of decisions after a long session. I suffer with significant compassion fatigue, to the extent where I can only hand out my patient satisfaction questionnaires in the morning, for fear of being a grumpy old cow in the afternoon.

How did we get to a position where I have to sit in the car for 10 minutes after I get home, or lock myself in the bathroom with a book, before I can face the demands of home life? The workforce crisis is a major reason; although some of the gaps have been plugged by allied health professionals, they just cream off some of the minor illness and routine reviews. We’re left with a surgery full of the mad, the bad and the sad – each to be seen within a 10-minute window.

I recently did the unthinkable. I opted to drop yet another clinical session, reducing from four to three, leading me to dip below the magic number for credibility. I had been thinking about doing this for months, but stubbornly persisted with working in excess of 50 hours a week, clinging on to the illusion of being a GP at the coalface. Standard 14-hour days are no longer doable.

So it is these coalface 9ers whom we should be honouring, not the GPs badged as influential leaders, who work only three to four sessions per week. These 9ers are the unsung heroes of the NHS, who turn up every Monday morning to prop up a failing system and get no credit for their loyalty and commitment.

I raise a glass to all of you, including my brother Nasir, because I can no longer do what you are doing.

Dr Shaba Nabi is a GP trainer in Bristol. Read more of Dr Nabi’s blogs online at pulsetoday.co.uk/nabi

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Readers' comments (17)

  • I am a 9er for now.But for how long I can stomach it I do not know.The 9ers are burning out thanks to the relentlessness of it all.A major change needs to happen and the "new contract" was not it.Epic fail BMA.

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  • In one way the 9ers are solid heroes doing their best for society.

    In another way they are perpetuating a system which is untenable.

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  • 9ers often have no choice.
    BUT, what about the 10ers?
    doing 5 full days 8am to 18:30 officially, but more likely much more, due to lack of available help?
    Required opening hours are 52.5 per week, which is time and a half, at least, but usually results in evening work after hours at least.

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  • Excellent article Shaba, thank you.

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  • Excellent article. It’s not just the hours but the intensity that has changed. I think of it like entering a war zone every time I go to work. It’s flat out physical and emotional onslaught- no breaks, no lunch or at best a lunchtime meeting and then back to the front. And it’s getting worse year by year. I had to reduce my sessions as it started to affect my health. And as you said, all my partners doing CCG, education etc think that part is a doddle. No wonder most newly qualified GPs want a portfolio career - which won’t be much help to many patients. Surely the PCNs will create loads of those posts again sucking even more clinicians out of the system.

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  • Beautifully written- days it all! Should be in national press!!

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  • Yes PCNs will mean lots of GPs sitting around in mostly pointless meetings whilst their colleagues are in the war zone that is frontline practice.. the ' management class' of General Practice and the corporate GPs who pay themselves lots of money to sit around in stupid board meetings have a lot to answer for..

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  • as a 9er I thank you for that Shaba. I'm glad you flag up the issue of nocters creaming off the easier bits so making our lists even harder to bear. I believe this 'nocter' direction is wrong and in my surgery we avoid it and fortunately still find the work load bearable but we are a fast vanishing traditional practice.

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  • Shaba I agree with you... its the coalface 9 and 10ers I support and respect. I agree with your observations about our leaders.

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  • Nocters can make our clinics much tougher . They take all the easy urti , rashes, pill checks. My clinic is then filled with patients on 3/4 th course of abx for UTI (usually given by noctor , no Ix instituted) complex mental health , recent hospital discharges with no diagnosis etc etc .all in 10 min intervals .Not to mention the sometimes inappropriate advise an inexperienced noctor can give for eg advising young patient with short hx of typical IBS symptoms they must request referral to get an upper and lower gi endoscopy!

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