NHS Enfield has come top in a study of the worst budget deficit of all primary care trusts in England.

Enfield has a budget of £450 million and is £17.5m in the red, according to the joint report by the Guardian and think tank Civitas, which studied the finances of 100 PCT trusts in England.

The trust, which has had four bosses in the last three years, is £7m further in debt than Sutton and Merton, the trust in second place.

Sally Johnson was the last permanent chief executive, and since she left in 2007 there have been three replacements: Tracey Baldwin, Stephen Conroy and Nigel Beverley.

Earlier this year, the Care Quality Commission (CQC) gave the trust's financial management the lowest rating possible on a four-point scale following its 2008/9 annual health check.

Only two per cent of all trusts received a "weak" rating this year, compared to 41 per cent three years ago.

The CQC report stated: "This organisation has failed to demonstrate the existence of adequate arrangements for the management of its financial resources.

"Improvements have been identified."

According to the report, more than a third of the 100 trusts surveyed are running deficits that have led to a cutback in surgical operations and seen calls to close casualty departments.

Bosses at Chase Farm Hospital, in The Ridgeway, are proposing to replace the A&E department with a 24-hour urgent care centre that will not take blue light ambulances.

NHS Enfield has predicted it will end the financial year with a £10.5m deficit, having reduced it from £26m a year ago.

A spokeswoman said the trust had reduced the debt through a programme that focused on efficiency savings "without compromising quality of services or patient safety".

Darren Cattell, interim director of finance, said: “NHS Enfield’s Better Value programme has delivered significant savings for the PCT and we will continue to develop the workstreams next financial year.

"Our priority is to ensure we commission high quality services for patients.

"Many of the projects involve investing in new services that deliver more care in the community, which should also deliver improvements in local NHS services.”