Aims: To describe otolaryngology access in rural northern NSW using Tamworth Hospital as a case example, and to outline the contribution and limitations of Indigenous outreach clinics in improving access. Methodology: Narrative review informed by local service data, waitlist metrics, referral patterns and published ENT outreach models. The structure of ENT care in Tamworth is described, with integration of observations from outreach activity. Results: Tamworth Hospital services a vast geographic catchment. Public elective wait times remain prolonged, with category 3 adults and children waiting up to nine years. Outreach ENT clinics occur in Inverell and Armidale approximately four times per year and provide episodic access closer to home. However, improvements in outcomes are variable and effectiveness is limited by inconsistent evidence quality, service coordination challenges, and sustainability constraints.1 Locally, similar barriers exist, including poor health literacy, high non-attendance driven by long waits, and inappropriate referral quality from primary care, all of which contributes to clinician frustration and service inefficiency. Conclusion: The Tamworth region demonstrates the structural reality of rural ENT access inequity in Australia. Indigenous outreach clinics remain essential in providing culturally safe specialist input where local services are limited but cannot alone offset service demand. Sustainable improvement will require coordinated strategies that combine visiting models, telehealth, local capacity building and targeted GP education. 1.Gotis-Graham A, Macniven R, Kong K, Gwynne K. Effectiveness of ear, nose and throat outreach programmes for Aboriginal and Torres Strait Islander Australians: a systematic review. BMJ Open. 2020;10:e038273.