Clinical commissioning groups have received a strengthened commitment from ministers to ensure their autonomy, and new powers to rate the performance of the NHS Commissioning Board.

The board will be held to account on whether it achieves “the best health outcomes for patients by strengthening the local autonomy of CCGs”. The earlier draft mandate had a vaguer commitment to “promoting” autonomy of CCGs and NHS providers.

There is also an additional pledge that every year the government will assess the board’s progress, inviting feedback from CCGs and other groups. HSJ understands that CCG leaders and senior officials hope this will help usher in an age of mutual accountability between the board and CCGs, instead of a one-way system in which CCGs are subject to top-down control.

The commissioning board’s role is described as “not a manager of the system, but a convener”. It will be responsible for “encouraging competition between peers for better quality”, but is also required to work with a number of partner organisations, including Monitor and the Local Government Association, to drive integration.

The DH believes a tranche of new transparency measures, for instance publishing outcomes data on “all major services”, will empower CCGs to measure themselves against their peers and assess local services.

“The question is not whether there is regional or local variation”, said health secretary Jeremy Hunt, “it’s how you best put pressure on people.”

The mandate confirms CCGs will be given “full control over where they source their commissioning support” services. However, the new document does not specify how the board should guarantee this.

Unlike the July draft, the final version includes an overt requirement on the board to ensure the delivery of both its own and CCGs’ contributions to the quality, innovation, productivity and prevention (QIPP) programme.

The earlier version had a vaguer objective about the programme as a whole.

The decision to make the board directly accountable for CCGs’ efficiency raises questions - which the mandate does not answer - about how the board will assess CCGs’ performance on QIPP.

So far, progress against the efficiency programme has been monitored through a combination of process milestones and savings outcomes. It is unclear how this will operate under the assurance framework for CCGs.

There is also no mention of what kind of sanctions are or are not available to the board if a CCG fails to hit its QIPP requirement.