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The NHS primary care trust in Suffolk has paid out £12m this month to finally clear its historic debt.
It follows a previous pay-out of £18.9m during 2007-8.
Costs have been cut through restructuring, the use of generic drugs and patients staying in hospital for shorter periods.
The trust said it is now free to invest about £17m in extending and improving services in the year ahead.
Chairman Alistair McWhirter said although the financial challenge was huge, but the hard work of staff means it can now concentrate on the future.
The trust will look to develop education programmes for people with long-term conditions, improving access to community health services and increasing talking therapies to help people with depression and anxiety.
Julian Herbert, Suffolk PCT’s director of performance, said: “We have worked really hard to reduce the debt, looking at every area of expenditure within the PCT.
“Our improved efficiency on spending has been helped by using generic drugs instead of more expensive branded medication, helping people avoid long-term stays in hospital and merging PCTs.
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