What is the Gera A&E Pressure Index?

The Gera A&E Pressure Index (0–100) is a Gera Systems measure that combines how often A&E patients wait longer than 4 hours with how many patients are affected at a given department. It is computed as (1 − Type 1 4-hour performance) × Type 1 monthly attendances, then min-max normalised across all 118 English Type 1 A&E providers, using only real NHS England March 2026 figures.

Why multiply breach rate by attendance volume?

A small department breaching the 4-hour standard 40% of the time affects far fewer people than a major trauma centre breaching it 40% of the time. Multiplying the breach rate by Type 1 attendance volume captures the total patient burden of long A&E waits, not just the percentage.

Is the index reproducible?

Yes. Every input is the real, published NHS England March 2026 A&E provider CSV under the Open Government Licence v3.0. The formula above is the complete calculation — anyone can download the same file and reproduce every index value exactly. Gera invents no numbers.

Which trust currently has the highest A&E pressure?

On the March 2026 data, University Hospitals Birmingham NHS Foundation Trust has the highest Gera A&E Pressure Index (100/100), reflecting 60.5% Type 1 4-hour performance across 34,602 Type 1 attendances. See its page for the full figures.

Does a high index mean a hospital is bad?

No. The index measures system pressure on emergency care — driven by demand, capacity and flow across the whole urgent-care system — not the clinical quality of a hospital. The busiest, most pressured departments are often major regional centres. The figure is a monthly average, never a prediction for any individual visit.

Gera A&E Pressure Index — Methodology

The complete, reproducible formula behind the Gera A&E Pressure Index, computed only from real NHS England March 2026 A&E data.

The formula

raw = (1 − Type1_4h_performance ÷ 100) × Type1_attendances

index = round( (raw − min) ÷ (max − min) × 100 )

where min and max are taken across all 118 English Type 1 A&E providers in the March 2026 release. The highest-pressure department scores 100; the lowest scores 0.

Step by step

Take the real source figures. For each NHS Type 1 (major) A&E provider, read the published "A&E attendances Type 1" and "Attendances over 4hrs Type 1" counts from NHS England's March 2026 A&E Attendances and Emergency Admissions monthly CSV (Monthly-AE-March-2026-revised-flkg42.csv). No estimates are introduced.
Compute the 4-hour performance. Type 1 4-hour performance = (1 − attendances over 4 hours ÷ Type 1 attendances) × 100. This is the share of major A&E patients admitted, transferred or discharged within 4 hours.
Compute the raw pressure. Raw pressure = (1 − Type 1 4-hour performance ÷ 100) × Type 1 attendances. This multiplies the breach rate by the volume of patients affected, so a busy department with many long waits scores higher than a small one with the same breach rate.
Normalise 0–100. Min-max normalise the raw pressure across all 118 English Type 1 A&E providers: index = (raw − min) ÷ (max − min) × 100, rounded to a whole number. The highest-pressure department scores 100; the lowest-pressure scores 0.

Highest A&E pressure (March 2026)

Top 5 English Type 1 A&E providers by Gera A&E Pressure Index
Trust	Type 1 4-hour performance	Type 1 attendances	Gera A&E Pressure Index
University Hospitals Birmingham NHS Foundation Trust	60.5%	34,602	100 / 100
Mid And South Essex NHS Foundation Trust	59.8%	28,522	84 / 100
University Hospitals Sussex NHS Foundation Trust	60.2%	27,989	81 / 100
Barts Health NHS Trust	61.3%	26,064	74 / 100
Northern Care Alliance NHS Foundation Trust	65.3%	27,062	68 / 100

For context, the England Type 1 4-hour performance was 63.9% in March 2026, against the 76% standard.

Why this index, and what it is not

Headline percentages hide scale: a small unit and a major trauma centre can share the same 4-hour breach rate while affecting very different numbers of patients. The Gera A&E Pressure Index weights the breach rate by attendance volume so it reflects the total patient burden of long A&E waits. It measures system pressure on emergency care — not the clinical quality of any hospital — and is a monthly average, never a prediction for any individual visit. Always call 999 for a life-threatening emergency.

Gera A&E Pressure Index: frequently asked questions

What is the Gera A&E Pressure Index?: The Gera A&E Pressure Index (0–100) is a Gera Systems measure that combines how often A&E patients wait longer than 4 hours with how many patients are affected at a given department. It is computed as (1 − Type 1 4-hour performance) × Type 1 monthly attendances, then min-max normalised across all 118 English Type 1 A&E providers, using only real NHS England March 2026 figures.
Why multiply breach rate by attendance volume?: A small department breaching the 4-hour standard 40% of the time affects far fewer people than a major trauma centre breaching it 40% of the time. Multiplying the breach rate by Type 1 attendance volume captures the total patient burden of long A&E waits, not just the percentage.
Is the index reproducible?: Yes. Every input is the real, published NHS England March 2026 A&E provider CSV under the Open Government Licence v3.0. The formula above is the complete calculation — anyone can download the same file and reproduce every index value exactly. Gera invents no numbers.
Which trust currently has the highest A&E pressure?: On the March 2026 data, University Hospitals Birmingham NHS Foundation Trust has the highest Gera A&E Pressure Index (100/100), reflecting 60.5% Type 1 4-hour performance across 34,602 Type 1 attendances. See its page for the full figures.
Does a high index mean a hospital is bad?: No. The index measures system pressure on emergency care — driven by demand, capacity and flow across the whole urgent-care system — not the clinical quality of a hospital. The busiest, most pressured departments are often major regional centres. The figure is a monthly average, never a prediction for any individual visit.

Explore the data

Contains public sector information published by NHS England and licensed under the Open Government Licence v3.0. Source: NHS England — A&E Attendances and Emergency Admissions, Monthly Statistics (March 2026, published 14 May 2026).