What are the downsides of IP telephony and VoIP?

The implications of an IP based telephony solution into three areas. These are outlined below:

Call quality and reliability of service
Prior to installing any IP based phone system a network health check can help to highlight possible issues, most of these issues can be resolved any potential costs incurred need to be balanced to create an overall cost saving before being explored further.
Costs - initial equipment, installation and support
Replacing a legacy phone system can be a large expense for a business. This expense needs to be balanced against the potential cost savings and increased functionality in the long term. Sometimes a brand new IP based phone system isn't the solution, instead an IP gateway might be.
Security - is someone listening in on your calls?
With your voice calls going over a data network there can be the ability for someone to listen to your calls. This is something that can be solved or restricted with the right solution and implementation.

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