Confidence in your mathematical ability and subsequent answers in an exam is key. During an exam you should be confident with the answers that you are giving which can be achieved with steady revision and attempts at questions from previous years exams. On the efficiency side, in a good deal of A Level exams it is possible to check if your answer is correct using simple checks or the use of your calculator. Its tricks like these that allow you to maximise efficiency during an exam, since once you know that you're correct you don't even need to look at that question again. Personally, I find scanning through the exam paper at the beginning and highlighting the question you know you can do straight away helpful since you can quickly answer questions, check said answers and have marks in the bag early. Overall, its little things like simple checks and using your time efficiently that can greatly improve your performance in not just A Level but subsequent exams at University.