King's College Healthcare trust is facing a £2.7m overspend half way through the financial year.
At a board meeting on Tuesday, the trust discussed recovery plans aimed at bringing it back to balance by the end of the financial year.
It will review spending plans and benefit from extra income for over-performance.
But one manager told HSJ he feared the only way balance could be reached 'would be by cancelling all elective surgery until the end of the year'.
Over the past five years the maximum deficit reached by the trust has been£1.7m.
The trust blamed the overspend on the high cost of agency nurses, the increased need for expensive specialist drugs and higher levels of nursing care. Director of finance Paul Forden was 'confident' the trust would break even at the end of the year.
Earlier this year the trust, led by chief executive Ron De Witt, hit the headlines over spending on refurbishments to offices. A spokesperson stressed that this year's overspend was purely in clinical areas.