The physical health inequalities experienced by people with mental health problems or learning disabilities are well established, though comprehensive data for England and Wales have not previously been available. Nor have the reasons for inequalities been examined in detail. The Disability Rights Commission in Great Britain set out to examine such inequalities in relation to primary healthcare and to establish what remedial actions are needed. A range of data-gathering mechanisms was used, including clinical data analysis, qualitative research, structured feedback from service users and professionals, and a high-level inquiry panel which took evidence from government departments and agencies and from national organisations. The data provide detailed evidence about inequalities and this paper sets out key recommendations for change.