Assessing how effectively NHS commissioners spend their funding receives greater importance in the latest government guidance on world class commissioning.

The revised version of the world class commissioning assurance handbook says competency number 11 - ensuring efficiency and effectiveness of spending - will be assessed as a core competency.

They have listened to everyone and tweaked year two accordingly

Competency six - to prioritise investment of all spending - is revised and now also requires primary care trusts to prioritise investment in different financial scenarios.

Reflecting the current financial situation, they are the most significant of the competency changes in the programme’s assurance handbook for year two, published by the Department of Health last week.

DH acting director general of commissioning and system management Gary Belfield said: “Commissioning has never been more important given the need for greater efficiency the NHS faces.”

The changes follow a comprehensive evaluation of world class commissioning assurance by the DH plus interviews and an online survey of more than 300 PCT and strategic health authority stakeholders. The handbook says overall world class commissioning assurance had been “judged a success” and was seen to be “rigorous and stretching”, with only “fine tuning” of the framework required.

Changes to the assurances include making the description of competencies, particularly sub-competencies, clearer about how the levels equate to different standards of performance.

Governance assessments are strengthened to differentiate more clearly between red, amber and green ratings; and better metrics have been introduced for some of the national outcomes, such as mental health and health inequalities.

NHS Birmingham East and North chief operating officer Andrew Donald welcomed the changes, which he described as “very subtle”.

He said: “They have listened to everyone and tweaked year two accordingly.”

He said the addition of competency 11 to the core list was “always going to be the case”.

“We are going to have to raise our competency in that area,” said Mr Donald.

At the end of world class commissioning assurance year two, July 2010, nationally calibrated results will be published by the DH to enable comparison across PCTs and improve the sharing of good practice.

Mr Donald said: “We need to link and share the learning,” and commissioners should “steal with pride” ideas from other trusts.