As HSJreaders will be aware, the Department of Health is keen to improve standards of commissioning in the NHS.

Much has been written in recent months about demand-management techniques (or rationing, as we used to call it) being the route to financial happiness. About the attractions of innovative 'spend to save' schemes built around the skills of newly recruited commercial experts and advisers. About why the modern GP should spend more time in commissioning meetings rather than actually seeing patients. Et cetera, et cetera, et boring cetera.

As HSJreaders will be aware, the Department of Health is keen to improve standards of commissioning in the NHS.

Much has been written in recent months about demand-management techniques (or rationing, as we used to call it) being the route to financial happiness. About the attractions of innovative 'spend to save' schemes built around the skills of newly recruited commercial experts and advisers. About why the modern GP should spend more time in commissioning meetings rather than actually seeing patients. Et cetera, et cetera, et boring cetera.

Now the DoH's preferred route to improving standards is generally what has become known as 'performance management', often qualified with the adjective 'robust'. For the DoH there is but one way of encouraging improved behaviour, and that is the Zinedine Zidane way. But we had also heard what we assumed to be wild rumours about some form of structured accreditation for commissioners, a kind of 'commissioner driving licence'.

Not for GPs, you understand - the British Medical Association would not stand for it - and probably not for nurses or therapists spending time in a commissioning role before returning to a proper job. This stuff is intended especially for managers. You know, the ones who keep whingeing on about lack of investment in their personal development. The ones who want to spend - heaven help them - their whole careers in commissioning.

Nevertheless I was surprised, to say the least, to open a brown envelope slipped under my door late one evening and find in it a draft exam paper for the new MSc in commissioning qualification. Clearly things have been progressing apace. True to our commitment to the freedom of the press, we reprint some of the paper below. You may wish - perhaps in a quiet moment between meetings - to try your hand at this intended rite of passage for the commissioner of the 21st century.

Incidentally, I was even more surprised to discover that this is apparently a joint initiative spanning that clear red water dividing the NHS in England from the NHS in Wales. Some say the Welsh NHS has never really tried commissioning; but it looks as if that is all about to change, and the new enhanced regional offices may soon have a pool of qualified, accredited and quality-assured commissioners to draw upon.

So, over to you, reader. Sit up straight and pay attention: you're not here to enjoy yourselves. Mobiles off, please. Pick up your pens. Begin.

Combined universities of middle England and mid-Wales, MSc in healthcare commissioning.

Paper 3: innovative solutions to complex commissioning challenges

Guidance to candidates: you have three hours to complete this examination. You should answer three questions: one from Section A (40 marks), plus any two from Sections B and C (30 marks each). Candidates from the NHS in Wales should not attempt any questions from Section C (privatisation) as this does not apply in Wales. Choose two questions from Section B instead.

Section A: demand management and maintaining financial balance

1 A group of local GPs is insisting on their 'right' to refer patients to a hospital some 10 miles away. Devise:

(i) three persuasive reasons why this would be harmful to the local NHS for such referrals to continue. Include estimated 'savings' that a change of policy might be expected to achieve;

(ii) an associated media campaign to justify limits on out-of-district referrals. (Note: please avoid the term 'repatriation', even as used by some NHS commissioners to describe bringing patients back to local providers. It is offensive);

(iii) an explanation of precisely why 'patient choice' does not apply in this instance.

2 Although your seniors wish to discourage delayed transfers of care, you believe they are keeping your organisation in financial balance because the hospital would only re-fill the beds. Prepare a press release consistent with both points of view and committing your organisation to no specific course of action. (Note: candidates using the term 'bed blocker' will have five marks deducted automatically).

3 Describe an effective strategy for controlling your expenditure on prescribing. Include an explanation of why you think your local GPs will comply.

Section B: commissioning along complex care pathways

4 Propose a strategy for commissioning local primary care services in 2007. Explain clearly what you intend to use for information.

5 A BMJarticle in December 2005 concluded that GPs with special interests providing a dermatology service cost nearly twice as much as a hospital-based service. Explain why this is not relevant to your local health economy, the specialty you are commissioning, or both.

6 Justify the closure of a small community hospital as a step towards integrated care pathways. Include key points for a briefing letter to the MP in whose constituency the hospital is.

Section C: privatisation

(Reminder: this section of the paper applies to the NHS in England only).

7 'There is no question whatever of &Quot;privatising&Quot; the NHS.' (Patricia Hewitt, 1 July 2006). Explain how this can be squared with an OJEU advertisement inviting private companies to take over large areas of NHS commissioning. (Candidates offering 'drafting error' as their sole explanation will score badly).

8 Offer a justification of the private finance initiative. Explain how it conforms with good commercial accounting practice.

When you have finished writing, please place your script on the desk (be sure not to write your name on it) and leave the room quietly. You are now free to go on holiday.