Purpose Regional hospitals across Australia rely heavily on locum consultant surgeons to maintain emergency surgical services. However, the impact of continuity of locum engagement on elective surgical and endoscopic access remains poorly defined. This study evaluates whether recurrent locum consultant engagement is associated with improved elective and endoscopic service delivery compared with short-term locum placements. Methodology A retrospective service evaluation was conducted using a prospectively maintained consultant logbook documenting all operative and endoscopic activity between March and December 2025. Data were collected across regional hospitals in Queensland, New South Wales, Victoria and South Australia. A regional hospital supported by recurrent monthly locum engagement (“continuity site”) was compared with multiple hospitals covered by short-term locum placements. Outcomes included elective and emergency operative volume, endoscopy activity and procedural case mix. Results At the continuity site, recurrent locum engagement supported substantial elective throughput alongside sustained emergency cover, including 111 colonoscopies, 53 gastroscopies, 23 haemorrhoid banding procedures and a broad range of elective general surgical operations. Emergency surgical activity remained significant and included appendicectomy, emergency laparotomy, bowel resection and emergency endoscopy for gastrointestinal bleeding. In contrast, short-term locum placements were predominantly emergency-focused, with limited elective and endoscopic service provision and minimal opportunity for planned follow-up or elective conversion. Conclusion Continuity-based locum consultant models enhance elective surgical and endoscopic access in regional hospitals while maintaining emergency surgical capacity. Structured continuity of locum engagement represents a pragmatic workforce strategy to reduce surgical access inequity across regional Australia.