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A tribute to the 9ers

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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