NHS Fife is struggling to break even as it identifies efficiency savings of £13.5 million.
The health board must plug a gap of more than £1.3m or it will fail to meet a statutory obligation set by the Scottish Government to end the financial year within budget.
In a report to the board, NHS Fife director of finance Chris Bowring said immediate action must be taken.
At Tuesday’s board meeting chief executive George Brechin called balancing the books ”incredibly difficult and incredibly challenging”.
Latest projections indicate NHS Fife is set to save around £12.2m by the end of March, against its £13.5m target.
The most significant overspends for the seven months to the end of October were on GP prescribing, consultant locum cover and bank nursing staff.
Prescribing services showed the largest overspend in the operational division at £2m, of which GP prescribing accounted for £1.7m.
Medical director Dr Brian Montgomery said: ”We are in the unenviable position of being top of the league table of the most expensive prescribers in Scotland.”
While steps have been taken to cut costs, including using generic instead of branded drugs, there has been a need for increased prescribing in some areas.
Dr Montgomery said: ”We’re reining in costs on one end of the seesaw, but expanding on the other. This is a common feature across NHS Scotland.”
General pharmaceutical services was £119,000 overspent, mainly down to pharmacist fees for methadone.
The finance report said: ”In relation to overspend in prescribing, a number of actions identified within the efficiency plan are expected to deliver additional cost reductions in the second half of the year.”
In planned care there was an overspend of over £1.2m. Factors included consultant locums for theatre, anaesthetics and orthopaedics.
There was also an overspend of £1.2m in emergency care, where bank nursing staff were brought in for care of the elderly, respiratory, cardiology and palliative care.
The report said: ”It is now critical that NHS Fife continues to implement financial recovery actions immediately and take other actions to control and reduce expenditure as far as possible.”