A primary care trust (PCT) says it expects to be £17.6m in debt by the end of the financial year.
The figure was revealed after Cheshire West PCT told the BBC News website it was expecting an end-of-year deficit of £14.9m.
The predicted debt was revealed in a report by PricewaterhouseCoopers (PwC) on behalf of the Audit Commission.
It said the trust overspent by £8m in the previous year after failing to find cost savings and a recovery plan.
The trust, which includes the city of Chester, fell into financial difficulties despite receiving cash from the Cheshire and Merseyside Strategic Health Authority (SHA), the report said.
'Difficult' year
It added that the trust might not be able to pay off its creditors without financial support.
Peter Chambers, of PwC, said: "The financial trend is symptomatic of an organisation that has not taken steps to manage its business.
"This is due to a combination of failure to identify service actions that would deliver cost savings, and failure to develop a robust and deliverable financial recovery plan once the need had been identified."
Trust chairman Bob Hodson said: "Cheshire West recognises that it must tackle the shortcomings highlighted in this report.
"As the auditors point out, financial pressures had been building up for some time, and the last year has been a very difficult one for the organisation."
The trust said it was working closely with external consultants and would submit a financial recovery plan to the Strategic Health Authority (SHA) next week.
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