England's major A&E units have now missed the waiting time target for 52 weeks in a row, official figures show.
Hospitals are meant to see 95% of patients who arrive at A&E in four hours.
But the last time the 144 trusts with major units met that over a seven-day period was in the week ending 14 July last year.
This contrasts to previous years when the target has been met during some of the warmer months.
However, NHS England officially measures the four-hour target on a three-monthly cycle and includes smaller units, such as walk-in centres, in the total.
By that measure, the target has been met over the past year.
But the weekly picture in the major units is another sign of how pressure is still bubbling away in the system despite it being summer.
Extra fundsThe latest weekly statistics, released by NHS England on Friday, take in the week ending 13 July. They once again show performance is below the 95% mark.
The number of visits to A&E units have been rising for a number of years. There were over 14.2m attendances last year - up 1.4% in two years.
But a bigger proportional rise has been seen in the number of these visits that end up with people being admitted into hospital. These tend to be the most complex cases that take the most time to deal with.
Of the 14.2m visits last year, just under 3.8m ended up with an admission into the hospital. That is 5.7% higher than two years previously.
Dr Cliff Mann, of the College of Emergency Medicine, said: "A lot of this is related to the ageing population and while the percentage rise may seem small we are still talking about a lot of people.
"We have a drastic shortage of doctors and that is hampering out ability to cope with rises in demand.
"We have to make the speciality more attractive."
The college has also called for measures to relieve the pressure on A&Es, including stationing GPs at units to deal with the less serious cases.
While England's A&E units are under pressure, performance elsewhere in the UK is even worse, particularly in Wales where under 90% of patients are seen within four hours and in Northern Ireland where it is under 80%.
Patients Association chief executive Katherine Murphy said: "We are increasingly hearing from patients about problems at A&E. It used to be just a winter phenomenon, but this shows it has become an issue all-year round."
She said she thought problems accessing GPs was a major factor.
Sarah Pinto-Duschinsky, of NHS England, said once the smaller units, such as walk-in centres, were taken into account the NHS was doing well and meeting the 95% mark.
"We are determined to maintain these high standards despite the pressure the NHS is under. NHS staff should be given the credit they deserve."
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