The prison population is disproportionately affected by risk factors for long-term conditions, has greater healthcare needs than the general population and is, overall, increasing and ageing. There are multiple challenges to the management of long-term conditions in prisons, including a disjointed healthcare system, a focus on security, a lack of health promotion, limited scope for prisoners to self-manage their conditions and limited budgets, staffing and training. However, a prison sentence can be an opportunity to improve access to treatment for long-term conditions for a disadvantaged and marginalised population. This article describes the challenges in the management of long-term conditions in prisons and discusses how these can be addressed through a more joined-up approach, better health promotion and prisoner engagement and improved staff training.