PATIENTS are being warned the way NHS services are delivered in York and North Yorkshire must change after the area’s primary care trust (PCT) announced it was facing a £19 million deficit.

Bosses at NHS North Yorkshire and York said it now faced “difficult decisions” and warned there was little chance of a bail-out after £18 million of “legacy debt” was wiped out last year.

Christopher Long, chief executive of NHS North Yorkshire and York, said: “The PCT has been in serious financial difficulty for a number of years and this must be addressed in order for us to protect the future of the area’s health economy.

“The way services are currently delivered in North Yorkshire and York is not sustainable, and we must look to new ways of working to ensure the Clinical Commissioning Groups (CCGs) are in the best possible position when they take over commissioning responsibilities in April 2013.”

The trust is now holding talks about whether the CCGs or the National Commissioning Board could inherit the debt.

Mr Long said: “We know there will be some difficult decisions to make over the coming months.

“However, we want to reassure the public that providing high-quality sustainable services remains our top priority.”

The trust said it would now be looking to ensure value for money in areas such as outpatient and out-of-hours services, monitoring the performance of contracted services and “reusing existing funding to support care closer to home”.

Key areas will include primary and acute care, mental health services and those for people with learning disabilities.

Corporate and back-office functions will also come under the spotlight.

NHS North Yorkshire and York described the £19 million debt as “historical” and put it down to “a range of factors including the relatively low funding allocation per head of population, the diverse geography of the county and a continued overspend on contracts”.

When North Yorkshire and York Primary Care Trust – NHS North Yorkshire and York’s previous guise – was created in 2006, it inherited £45 million of debt incurred by the county’s former health trusts. The debt was eventually wiped out.