Key Points 1. During the COVID-19 pandemic, NHS cancer referral guidance recommended a move from face-to-face clinics to telephone appointment. In this study, we reviewed the safety of telephone clinic for urgent 2-week wait cancer referrals. 2. In the 7 months study period during the COVID-19 pandemic, 1062 urgent 2-week wait cancer referrals were received in our regional head and neck specialist unit, reflecting a 7.3% decline compared to pre-pandemic data. 3. At 6-months follow-up, 98 (9.2%) patients received a new diagnosis of malignancy. 95 of them received their diagnoses promptly after their initial telephone clinic, whereas 3 patients received a delayed diagnosis. 4. There is a late diagnosis rate of 0.28% but we discussed in our cases that late diagnosis does not inevitably lead to worse clinical outcome or harm. 5. Telephone clinics will likely remain in some capacity after the pandemic, while telephone clinics are pragmatic means to maintain patient flow during the pandemic, they could result in risk of late diagnosis.