The delivery of health care to people with a learning disability living in the community has come under increasing scrutiny. Concerns have been raised over both the current quality of this care and its future organisation. In this article we review the evidence on current practice focusing on epidemiology, health status and policy directives affecting primary health care. Four specific areas for service developments are identified: an individual focus within an epidemiological framework, the evaluation of the effectiveness of current therapies, practice organisation and the awareness of health within social care. It is proposed that an effective model of primary health care is possible, supported by research, training, inter-service collaboration and purchasing guidelines.People with a learning disability and their families look to the general practitioner as the linchpin of health care provision. Indeed general practitioners, and by inference the primary health care team, are the most frequently contacted professionals by individuals with a learning disability (Evans et al., 1994). This central role is confirmed by general practitioners themselves (Kerr ef al., 1996). While the current move from hospital to community residential provision has focused attention on the role of the general practitioner as a generic primary provider, it is not a new position for them to occupy as the majority of people with a learning disability have always lived in the community with their families (DHSS, 1971). However, people with learning disabilities constitute only a small proportion of any general practitioner's list and their particular health care needs, therefore, require special highlighting or organisation to be dealt with effectively. In addition, people with learning disabilities are significant consumers of other professional services and social care support. A means of producing and reviewing co-ordinated health, education and social care packages is essential if services are to be responsive to the needs of individuals throughout their life span. This paper reviews the scientific and policy evidence to discuss how primary health services can best be organised within such a framework to maximise the health of people with a learning disability.