The forecast overspend by clinical commissioning groups this year has increased by almost £70m in the last month, as local leaders struggle to hit efficiency targets.

After the first six months of 2016-17, the projected outturn for CCGs at the end of the year was an £190m overspend. At the end of month seven, this had increased to £256m, according to NHS England’s latest finance report.

The year to date overspend is £293m, compared to £236m in month six.

The report, written by chief finance officer Paul Baumann, says: “There are 93 CCGs reporting year to date overspends, of which 53 are greater than 1 per cent. Roughly half of these CCGs are assuming that they will be able to recover their financial position by the end of the year…

“All CCGs facing potential overspends are fully engaged in mitigating actions, with additional intervention where necessary by NHS England regional teams.”

The Midlands and East region accounts for almost half of the deterioration.

However, the deterioration of CCGs’ finances is again expected to be offset by underspending in other areas of NHS England’s budget. The forecast underspend in “other central budgets” has increased by £50m. HSJ has asked NHS England to explain the increase but has not yet had a response.

The year to date position for NHS England is an overspend of £221m, compared to £168m at month six, however this is projected to improve to £7m by the year-end.

This does not include the £800m “risk reserve” CCGs have been forced to hold back to cover overspending in the provider sector. Once this is accounted for, it would net to an overall underspend.

On average, CCGs are required to deliver efficiency savings of 3 per cent this year in order to break even, up from 2 per cent in 2015-16.

Although the provider sector has planned for a deficit of £580m this year, experts have warned this position could worsen significantly by March 2017.

In 2015-16, NHS England recorded an overall underspend of £599m, much of which was achieved through one-off measures. It helped the Department of Health narrowly avoid a formal parliamentary process to ask for more money. Within this, CCGs reported a combined overspend of £16m.