The issue of travelling to attend a colonoscopy from rural and possibly remote locations is a primary concern for patients and can affect the uptake of colonoscopy services. The issue is exacerbated by the need to take powerful laxatives possibly prior to travel and furthermore by the potential lack of public toilets on the route travelled. Also, the potential need for sedation during optical colonoscopy will restrict driving soon after the procedure.

The cost of travel (and accommodation if necessary) is borne by the travelling patient and so may be hidden from the costs of the service provider.

The video capsule endoscopy is diagnostic only which is the obvious difference from an optical colonoscopy in terms of capability within the procedure. There is potential for many people to have a video capsule endoscopy. Some patients would then need to have an additional optical colonoscopy for polyps to be removed. In this case the video capsule colonoscopy has cost the patient and NHS Scotland extra effort and money.

Correct screening and vetting by GPs and Gastroenterologists is critical to avoid the unnecessary choice of a video capsule colonoscopy. Additionally, it needs to be made clear what the clinical governance is in the vetting process. Appropriate information for the patient (patient information leaflet) is required to communicate the reasoning for the optical or video capsule decision, to improve patient understanding if an additional therapeutic intervention should be required after the video capsule process.

On the positive side, the SCOTCAP service could lead to:

• vastly better patient experience where only a diagnostic colonoscopy is needed. For example, with recurring inspections;
• more people having a diagnostic colonoscopy that would not have normally taken the option to have a colonoscopy procedure.

The number of staff required for an optical colonoscopy benefits from economies of scale as the procedures are concentrated at Raigmore Hospital, Inverness. The SCOTCAP service would require small amounts of time from distributed nursing staff. This raises an issue for training and equipment provision as relatively few video capsule endoscopies could be done in some rural areas due to low population numbers. During the workshop participants were unsure of what effect rurality has in this instance and how best to hire and train staff to deliver the SCOTCAP service.

Corporate Health nursing staff could deliver the SCOTCAP service in remote areas where NHS Scotland do not have sufficient staff or sufficiently trained staff. Patient participants at the workshop thought this would not affect their trust in the service. Participants wished that the service could be delivered entirely by NHS Scotland (in terms of nurses, not the analysis and reporting) but thought that there could be an intermediary period where Corporate Health could deliver the service until the demands of the service were better understood. At which point the service could be brought into NHS Scotland with a clear understanding of the staff requirements.

It is envisaged that the SCOTCAP service could be delivered at a local medical centre or at the patient's home. The two participants at the workshop who had trialled the video capsule endoscopy as part of the current trial said that, while their own home would be preferable, their local medical centre was a familiar environment and would be preferable as well.

Feedback fell into two opposing categories:

• the feelings of safety and control that come from being in your own home and obversely;
• the doubt and anxiety brought about by poor instructions and belt ergonomics.

There were three tasks that were identified as needing to be done Before the SCOTCAP service is launched or before the trial is finished:

• The information leaflets and video capsule equipment instructions need to be written/improved and this should be tested as part of the trial;
• All material given to the patient needs to be ratified by NHS Scotland and;
• Booking arrangements for the SCOTCAP service need to be brought into formal NHS Scotland facilities (i.e. SCI Gateway).

Note that these are tasks identified at the workshop and there is more that needs to be done before the SCOTCAP service can be launched. The general impression from clinical staff at the workshop was that the process currently is cumbersome, using a variety of systems/services to deliver a video capsule endoscopy.