The NHS in Yorkshire has for years papered over the cracks of financial unsustainability in its second largest organisation, North Yorkshire and York Primary Care Trust.

Overspending in the patch has previously been subsidised by other areas which have been making a surplus.

North Yorkshire faces an even more severe crisis if the government sticks by the rhetoric of last year’s white paper, which declared: “We are very clear that there will be no bailouts for organisations which overspend public budgets.”

GPs have been told if they become commissioners they should not have to take on debts run up while they were not behind the wheel.

But, if the cash shortfall is too large, it will be hard to keep the promise. The prospect of taking on an enormous debt, in an increasingly unaffordable health economy, will surely dampen GPs’ enthusiasm.

The situation is replicated to various extents in other regions. What sets Yorkshire apart is that last month the strategic health authority decided to admit it had a problem and attempted to grasp the nettle, by commissioning an independent review chaired by NHS Confederation medical director Hugo Mascie-Taylor.

The situation is replicated to various extents in other regions. What sets Yorkshire apart is last month the strategic health authority decided to admit it had a problem and attempt to grasp the nettle, by commissioning an independent review chaired by NHS Confederation medical director Hugo Mascie-Taylor.

The problems it outlines - and its likely recommendations - could spell trouble for the acute sector, where most of the money is spent.

Some providers are cautiously lining up structural changes to prepare for the squeeze. York Teaching Hospital Foundation Trust deputy chief executive Mike Proctor has also become acting chief executive of Scarborough and

North East Yorkshire Healthcare Trust as the two organisations move towards a potential merger.