NHS England has announced the piloting of an app that allows patients to access a GP through their smartphone.

GP services offered through the app will compete with existing bricks and mortar services, and represents a massive injection of competition into primary care services.

Patient migration to the app-based service will leave existing GP practices with fewer patients and smaller incomes.

GP practice consolidation, which is already happening as private firms and acute trusts acquire or merge with GP practices, can be expected to accelerate significantly in response.

It is easy to see a future where the app, by increasing competition in GP services significantly reduces the number of bricks and mortar GP practices that patients can choose between.

This kind of structural change poses a significant challenge for the Competition and Markets Authority (CMA), which has largely ignored GP consolidation so far.

Unregulated consolidation among bricks and mortar GPs has the potential to eliminate practice choice for patients who do not wish to use the app.

App-based GP services may well be a sufficient competitive constraint to local monopolies of bricks and mortar GPs owned by acute trusts or private sector businesses.

However, the time is coming when the CMA is going to have to take a look at the various mergers, acquisitions and other transactions in the sector and work this out.