"It won't fix the short-term problems like recruiting staff," he said.

"We're all drawing from the same pool of medical service providers for medical and nursing staff."

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Having now informed his fellow board members that he won't be continuing with the advisory group, he said in his opinion Tenterfield's problems stem from being at the end of the line, regardless of which direction you're coming from.

Dr Unsworth was part of the 2017 health summit in Tenterfield organised by then-MP Thomas George. It was attended by Hunter New England Health CEO Michael DiRienzo and his Northern NSW Health counterpart Wayne Jones, who remain in their respective roles.

Mr Di Rienzo had indicated a willingness to work with the community and hospital to address concerns and to ensure all services are available, leading Mr George to feel that the move to a new health district wasn't a foregone conclusion.

Unfortunately ongoing issues over the intervening two years, culminating in the recent six-day gap in doctor availability at the hospital and a man's death in the emergency department, have undermined the community's confidence in that assertion.

The difficulty of obtaining locum or permanent medical staff is a huge issue and Tenterfield is not alone in regional and rural areas.

Councillor John Macnish also attended the 2017 meeting and continues to be a strong proponent of the health district move. He combined with Cr Bronwyn Petrie at this month's council meeting to present a motion that Tenterfield moves to Northern NSW Health, along with other demands of the NSW Health Minister for immediate improvements at the hospital. It received council's unanimous support.

Hunter New England Health is happy to work with any discussion to transition to a different district, according to Cr Petty. Dr Unsworth, however, recalls that Northern NSW Health was not too keen on taking us on.

"I feel the message came through loud and clear that Lismore was not overly-enthused," he said.

He put this reticence down to geography, with Tenterfield's position on the tablelands, in contrast to the district's coastal plains communities, again making the shire an outlier on any health district map.

He said the ambulance service has policies making road transfers from Tenterfield to Lismore difficult, particularly for obstetrics cases, due to wide gaps in mobile phone coverage along the route. Armidale on the other hand, Dr Unsworth said, has a new hospital and good staff.

Tenterfield women having babies tend to attach themselves to Stanthorpe Hospital and many residents, like himself, see specialists in Toowoomba or Brisbane.

So getting to your health specialist of choice is generally not an issue, until it's an emergency. Dr Unsworth said Northern NSW Health does not have the cross-border issues that Hunter New England has, having entered into agreements long ago that allow ambulances to take patients across the border into Queensland Health's hands.

Unfortunately he doesn't feel the same cross-border arrangements would extend to Tenterfield, should it move to that district. Efforts to resolve the issue under the current regime haven't been fruitful.

"We've been trying to make it work, but there are major problems that are not able to be sorted."

While there could be some synergy from Lismore being the base for both the rescue helicopter service and Northern NSW Health, Dr Unsworth said there are pros and cons for both health districts, and nursing and medical staffing is likely to remain a major issue either way.

"We haven't got a good deal either way, we're still the end of the line like a plum at the end of a branch.

"We're a small community but a vital community. I just feel we've been put into the 'too hard' basket by HNE Health."