By Branwen Jeffreys
BBC News, health correspondent
The latest financial report from the NHS in England suggests it is on course to end the year in overall balance.
Patients are healthy and wealthy in Cambridgeshire
But some parts of the country will still be left struggling with big deficits.
In Cambridgeshire the primary care trust (PCT) is forecasting an overspend of £52.4 million by April.
Compared to many other parts of England Cambridgeshire is generally healthy and wealthy.
Despite pockets of poverty people live longer than average and suffer less from serious disease.
But these twin blessings of health and wealth are partly to blame for the financial crunch being faced by the NHS here.
Poorer areas with more ill health get a bigger share of the total health service budget, so Cambridgeshire starts off with less money than some other counties.
But instead of spending less than poorer areas it has been spending more.
Patients here are more likely to be spent for expensive hospital tests and treatments.
The PCT is now on course for an accumulated deficit of more than £50 million on a budget of around £600 million.
Every aspect of its spending on patients is now being reviewed.
Meanwhile, Durham PCT, which looks after many deprived communities, is trying not to underspend.
Its patients include Tony Blair's constituents in Sedgefield.
Dr Guy Watkins is the chief executive of the Cambridgeshire Local Medical Committee, which represents GPs.
He said: "For every £1 the government spends on healthcare for the people of Durham we get about 70p. But the prices for treatment at set nationally."
So Cambridgeshire is getting a gradually smaller slice of NHS money and is trying to pay off its deficit at the same time.
That means tightly controlling drugs budgets and trying to bring down hospital admissions.
As Dr Watkins puts it, the level of health care provided in Cambridgeshire is "too good".
"We are going to have to level down."
Oak Tree Health Centre runs a foot surgery unit where around 200 patients a year can be treated.
Scrubbing up for operations, surgeon Andrew Frances Flores expalined they can carry out complex proceedures that a decade ago would have been in hospital.
"Our costs here are roughly two-thirds of a big hospital for exactly the same treatment, because we don't have the same overheads."
To solve its financial problems the PCT will need to make similar savings many times over.
But other measures may be more controversial, like limiting access to new expensive drugs approved by the National Institute for Health and Clinical Excellence (NICE).
But some GPs see the review of spending as a levelling down to less good care.
Dr Peter Bailey looks after patients in the new town of Cambourne.
This surgery sends a relatively high number ot patients on to hospital - he said his educated patients often come armed with internet print outs and a clear set of expectations.
Dr Bailey said: "Our patients are responding, if you like, to the advertising.
"The NHS is improving, waiting lists are coming down. Of course they're going to ask for more. Now we're telling them you can't have that - it's a complicated message."
A complicated message indeed. County councillors have a watchdog role for local NHS services.
Geoffrey Heathcock, chairman of the health scrutiny committee, said there was a huge dissonance between the national NHS progress to financial balance and local experience.
He said: "Patients will say it's not in balance in my backyard, at my GP surgery, having to wait a bit longer if I need to go into hospital"
There is little doubt that further hard decisions face the NHS in Cambridgeshire as the PCT tries to live with in its means.
It is one area likely to be struggling with deficits long after the nhs overall has declared itself back in balance.