The growth in the number of people with learning disability living in the community presents a major challenge to primary care services. There is a high prevalence of physical and mental illness among these patients, but disorders may be inadequately managed. This reflects problems of access to primary care services, and problems of liaison between services. Policy options for improving primary healthcare provided to people with a learning disability include: specific monitoring by FHSAs; improved training; clarification of responsibility for medical care; regular medical examinations; and improvements in information systems.