By politics.co.uk staff
Nick Clegg will instruct Lib Dem MPs to vote against NHS reforms if David Cameron does not accept his demands, according to reports.
A paper written by the deputy prime minister headed 'NHS reforms: changes required' lists four key concessions sought from Mr Cameron.
Lib Dem support will be withheld unless the health and social care bill is amended so that "any suggestion that we are pursuing a dogmatic obsession with competition [rather than] the best healthcare system in the world" has been removed.
Mr Clegg also wants an undertaking that GPs will not be forced into forming consortia until they are "ready and willing", steps taken to prevent "the cherry-picking of services by private providers" and assurances that governance and local accountability will be improved.
"It is clear that the NHS does need to be updated if it is to meet patients' needs and provide world class health care in the future," the Liberal Democrat leader wrote.
"But the reforms as originally set out would not achieve that goal, would not protect and sustain our NHS and have clearly very little support among NHS staff or the wider public.
"I will not ask my parliamentary colleagues to support legislation on the NHS until I am personally satisfied that the reforms have been substantially changed to ensure our NHS is secure for the future."
Removing support for the health and social care bill from the junior coalition party would be an unprecedented step for Mr Clegg.
But it is in keeping with his promise of a more "muscular liberalism" in which the Lib Dems adopt a more confrontational, uncompromising approach with the Conservatives.
The new stance has prompted criticism from Tory backbenchers, including health committee chair Stephen Dorrell.
He pointed out that competition is already a fundamental part of the NHS and commented: "The idea there is no competition is just bonkers."
The NHS Future Forum, which is undertaking the 'listening pause' as the government reconsiders its options on the stalled health and social care bill, is delivering a progress report to Mr Cameron, Mr Clegg and health secretary Andrew Lansley later today.