In this article, the authors describe the changes required to introduce a nurse telephone triage system into a large primary care practice in York. 'Whole systems' changes were necessary in that not one element of the primary healthcare team (PHCT) system has remained unaffected. The introduction of nurse triage has changed working practices, professional working relationships and job satisfaction. Far from being just a workload management solution, it has fundamentally altered the way that nurses, doctors and reception staff work together and with patients.