An editorial notes that some of the study’s shortcomings have been acknowledged by the authors. The effect of telephone first on other parts of the health service, such as nursing and pharmacy, were not measured. Commercial companies marketing the systems provided appointments data, and it is unclear how they overcame the difficulties in analysing routine appointments data; also large amounts of data about the duration of appointments were missing and had to be imputed. The safety of telephone consulting was not covered, and the reported increase in emergency admissions associated with telephone first systems is of potential concern. It suggests that telephone consulting could work well for patients with straightforward problems or those needing routine follow-up. However, it is unlikely to lower workload and might make it easier to access an initial consultation, resulting in increased workload in the short term and greater problems long term through supply induced demand. It concludes that “Telephone first systems alone will not solve the perennial problem of ensuring timely, safe, effective, and equitable access to primary care when demand is increasing and resources are not.”