In 2015 our small rural hospital was facing increasingly uncertain permanent medical staffing with no ED specialists, 2 physicians approaching retirement, 2 obstetricians and 1 surgeon. Ongoing efforts to recruit into vacant positions were unsuccessful and services were increasingly locum dependant We will describe the growth of a core of NZ trained Rural Hospital Medicine Specialists enabling the successful establishment of a unique emergency, inpatient medical and interventional obstetric model. Discussed will be barriers both cultural and regulatory, mistakes and successes including exploitation of crisis to achieve improved service delivery Differing solutions to formalise and normalise collaboration with specialist colleagues have been developed and two of these will be demonstrated. We will also demonstrate non inferiority to more traditional models of care and describe what we see as our next steps.