When they say "out-of-the-box" they mean when you use it as advertised.
If you look at the comparison chart here:
You will see that it is for PayPal Pro not remote checkout (PayPal Standard), US Lbs. and US dollars. Obviously it is going to require a lot of modifications to use in the UK with an unsupported payment gateway.
The Spam status is determined by the email servers and email clients.