North Yorkshire's health care bosses have approved cost-cutting measures to clear a £45m debt.
Surgeons face difficult decisions because of the overspend
The North Yorkshire and York Primary Care Trust is the most overspent organisation in the NHS.
At a meeting in Harrogate on Tuesday managers decided on plans to cut debts within the next three months.
They agreed to measures including some hospitals refusing to treat "trivial" cases in casualty, and delaying some patients' non-urgent operations.
The trust's chief executive Dr Janet Soo Chung said the debt was critical.
Dr Soo Chung said: "The primary care trust is currently overspent by £45 million a year and we are being subsidised in that overspending by other NHS organisations in the area, so it is vital that we get a grip on this very quickly.
"It's inevitable that these proposals will cause some concern and unhappiness, what we are doing is looking to slow down some areas of activity, and in a small minority of cases, some patients will wait longer for their treatment or surgery."
She said some patients waiting for non-urgent procedures such as the placement of ear grommets could find their cases being reviewed.
"It depends on the urgency of the case and the view of the GP or referring clinician and certainly the primary care trust is going to put in place an exceptions panel to consider all patient cases based on the individual details for that patient."
"What we are not doing is imposing a blanket ban on any intervention or procedure. Any decision made in terms of patient care will be made by clinicians and not managers or administrators.
"We are enabling clinicians to make exceptions where they believe it is clinically necessary for patients to receive care."
"If patients are currently on waiting lists and already have dates for treatments then those dates will be honoured.
"In other cases if their GP or their consultant feels that their case needs to go ahead and that treatment needs to take place then the PCT will consider that very carefully."