The Italian health care system delivers high quality of primary care services as demonstrated by rates of avoidable hospitalisation that are amongst the lowest in the OECD. Italy faces, however, a growing ageing population and a rising burden of chronic conditions, which are likely to result in higher health care costs and place further pressures on the primary care sector. Whilst the management of chronic conditions requires a co-ordinated patientcentered response from a wide range of health professionals, the Italian health care system has traditionally been characterised by a high level of fragmentation and a lack of care co-ordination. Italy has made considerable efforts to experiment with new models of community care services that aim at achieving greater co-ordination and integration of care. Although the expansion of community care services is an appropriate policy response to meet the growing demand for health care, they are still unevenly distributed across Italian regions and autonomous provinces. Greater guidance and support from national authorities is needed to ensure a more consistent approach. At the same time, there are other shortcomings in Italy’s primary care sector that require attention to guarantee high-quality primary care. Efforts are needed to increase transparency, develop performance measurement and strengthen accountability in the sector. The development of a set of standards around the processes and outcomes of primary care, the setting-up of smarter payment systems and an increase in the involvement of primary care physicians in preventive activities are options that Italy should consider pursuing if it is to meet the challenge of an increasing burden of long-term conditions.