Purpose Endoscopic Retrograde Cholangiopancreatography (ERCP) is the standard treatment for patients with obstructive biliary pathology. Although ERCP is readily available at tertiary centres, some rural hospitals in New Zealand lack on-site ERCP and depend on interhospital transfer for this service. In the Bay of Plenty region, Tauranga Hospital is the regional hospital that provides acute ERCP and MRCP for both itself and the rural Whakatāne Hospital. There is a one hour travel distance by road between these hospitals. We aim to determine whether there are equitable outcomes for rural patients requiring ERCP via interhospital transfer compared to direct admission to a regional centre with on-site ERCP. Methods A retrospective audit was conducted of all patients who underwent acute ERCP between 2021 and 2024 at Tauranga Hospital, stratified by admitting hospital. The primary outcome was the time from admission to ERCP, and secondary outcomes included time to MRCP and peri-procedural outcomes. Results A total of 251 ERCPs were performed (194 Tauranga, 57 Whakatane). Patients from Whakatāne had a slightly longer time to ERCP (median, 5 vs. 4 days; p = 0.002). There is a slight delay in time to MRCP for patients from Whakatane (median, 2 vs. 1 days; p=0.020) otherwise there were no statistically significant differences in secondary outcomes between the two centres including LOS, procedural success, complication rate, readmission and mortality. Conclusions There is only a one day delay in time to ERCP for patients presenting to Whakatāne Hospital compared to Tauranga Hospital without any difference in peri-procedural or mortality outcomes. This suggests that interhospital transfer for ERCP is a safe and equitable care for rural patients. This delay to ERCP may be partially attributable to the delay to MRCP, which, for Whakatane Hospital, also requires interhospital transfer due to the absence of on-site MRI.