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The impact of Agenda for Change, NHS reconfiguration and financial restraints on diabetes health care professionals and specialist services is unknown. There has been considerable concern, however, that these initiatives have resulted in significant reductions in specialist diabetes services. The aim of this study was to investigate the effect of the recent NHS changes.Paper questionnaires were sent to 484 diabetes specialist nurses (DSNs) who were asked to complete the survey on behalf of their local multidisciplinary team and to 500 people with diabetes (user representatives [URs]).In all, 162 (33%) of the DSN questionnaires and 77 (15%) of the UR questionnaires were returned. Forty-three percent of DSN respondents indicated that posts had been frozen, while 26% reported unfilled posts following maternity leave or retirement. Nine percent and 32% described redundancies and downgraded posts respectively. DSNs and paediatric DSNs were the staff groups most affected by budget cuts. Forty-five percent identified reduced access to professional development and 40% reported denied requests for study leave. The impact on people with diabetes was significant, with 55% of DSN responders highlighting reductions in patient contact time and increased delays in patients' access to DSNs and consultants. Thirty-four percent reported that specific diabetes services had been cut. Fifty percent of DSNs reported reductions in home-based care and 49% reported decreases in patient education provision. These results were mirrored by the user representative survey.These findings indicate a major adverse effect of Agenda for Change and NHS reforms on the provision of diabetes specialist services and access to continuing professional development. Copyright © 2007 John Wiley & Sons.