Background
The problems in maintaining seamlessness when the responsibility for the care of patients is transferred from the secondary to the primary care sector, or vice versa, are well recognised. However, the resolution of such problems is proving elusive, especially with respect to ensuring that medicines required by patients are readily available. The quality of care is compromised if medicines are incorrectly prescribed or if a medicine cannot be made available because of a breakdown in communication or disagreement in priorities. One reason why these imperfections in the primary / secondary care system are perpetuated is that patients, carers and health care professionals tend to resolve problems individually. This means that 'gaps' resulting from discontinuity of care leading to unsatisfactory management of medicines tend to be patched up on a 'crisis management' basis. The original root cause of such problems, however, often tends to remain inherent within the health care system. The aim of this research was, therefore, to 'map' the medicines management process and to identify the causes of 'gaps' in the health care system that may lead to the unsatisfactory management of medicines. Based upon this information, this research proposes strategies in order to tackle the cause of communication failure and thus to enhance the quality of patient care.

Method
The researcher (JB), whilst being employed as an 'Interface Pharmacist' carried out in-depth interviews and focus groups with community pharmacists and GPs (in the primary care sector) and with hospital pharmacists and consultant doctors (in the secondary care sector). These techniques were used to ascertain the separate perspectives of these professional groups and to obtain their opinions as to where 'gaps' in the medicines management process lay and how they might be bridged in the future. Verbatim transcripts were obtained from the tape recordings of these interviews from which a content analysis was performed based on grounded theory.

Results and discussion
Each professional group provided explanations for 'gaps' arising in the management of medicines. These included: a) poor communication, b) lack of information, and c) failure to adhere to policies that had been agreed between the primary and secondary care sectors. Hospital doctors and pharmacists rarely communicate with community pharmacists when making arrangements to transfer the responsibility for care to the primary care sector. Primary care practitioners, especially community pharmacists, feel that they spend considerable time and effort that might otherwise have been avoided with forethought, planning and simple communication. The implications of this information are discussed with regard to improving patient care at the primary / secondary care interface.