In this chapter, language issues and students’ level of communicative competence are examined. Two predominant theoretical models are examined, relying on cognitivist and situated approaches, respectively. The situated approach, supported by the discourse work of Gee (2005, Establishing scientific classroom discourse communities, pp. 19–45) is found to be better aligned to the notion of epistemological access which is linked to the notion of academic literacies and is recommended as an approach to assisting students with academic reading and writing. The chapter also examines models of language support offered in access programmes, which range from being integrated into the academic discipline to a separate generic language course. Various research findings are reviewed on improvement of students’ reading and writing. This chapter concludes by emphasising the centrality of writing and communication to the academic enterprise and the need for a holistic approach.