Introduction
The Department of Health set a target date of 2004 for the implementation of medicine management schemes in all primary care organisations in England1. Medicines management encompasses a number of aspects some of which include prescribing support, widening access to medicines and improvements at the primary/secondary care interface. Prescribing issues arising at this interface have long been acknowledged and debated. This study aimed to explore prescribing issues that arise at the interface from both a PCT and practice level perspective. This paper focuses on the similar and contrasting views between PCT and practice level participants.

Method
General practitioners (GP) working in three Primary Care Trusts (PCT) in England were approached to participate in an ethically approved exploratory study. Semi-structured interviews, using a piloted topic guide, were conducted with 14 GPs across three PCTs. [PCT1 n=5, PCT 2 n=2, PCT 3 n=7]. The pharmaceutical adviser/prescribing lead in each PCT was also interviewed. The audio-taped interviews were transcribed verbatim and analysed using the "framework" approach with the aid of N-VIVO version 2.0.

Results
A number of similar and contrasting views were raised by both PCT and practice level interviewees about prescribing at the interface. At a practice level, GPs had a number of concerns some of which related to monitoring issues, protocols and the practicalities which such issues raise for safe and effective prescribing. The cost of prescribing certain expensive drugs transferred between primary and secondary care did not appear to be a main concern for most GPs. At PCT level, the focus firmly remained on expensive drugs obtaining the necessarily approval and cost-effective prescribing. GPs varied extensively in their willingness to inform the PCT of their intention to prescribe expensive drugs an action which, at a PCT level, was felt unnecessary in some cases. GPs expressed little knowledge of the existing guidance on prescribing responsibility in relation to a number of specialist medicines, and appeared likely to contact PCT level staff about such issues. Although PCT level interviewees were surprised by GPs lack of awareness of such guidance, poor dissemination and communication were suggested by one PCT as a reason for GPs' lack of knowledge. GPs who were concerned about prescribing drugs when they had not been part of the decision making process were likely to seek assistance from their pharmaceutical adviser regarding such issues. GPs considered contacting the consultant directly about such an issue to be part of the pharmaceutical adviser's role, a view which pharmaceutical advisers themselves shared.

Conclusion
Although in these PCTs a lot of effort has been applied to tackling problems arising at the interface, this study indicates that a gap still exists between PCT and practice level staffs' views on the presented prescribing issues. This study also suggests how closer workings between PCT and practice level staff are needed to improve the future delivery of medicine management services.