Abstract Regional groundwater resource models are often built to improve confidence in predicted groundwater abstraction impacts on river flows and groundwater levels. By explicitly representing the aquifer system geometry, properties and boundaries, together with transient recharge and abstraction pressures, such models provide a robust platform to support abstraction impact assessment, alongside evidence from field data and investigations. Regulatory drivers include the European Union Habitats and Water Framework Directives and other abstraction licensing decisions. This paper presents examples of the spatial and temporal patterns of groundwater abstraction impacts predicted by several models. A variety of presentation formats are used to illustrate the simulated flow impacts of abstractions both individually, and in combination with other surface water abstractions and discharges. Model predictions from a range of abstraction, aquifer, and river settings are often more complex than would be suggested by simpler tools and approaches. In many cases, absolute low-flow impacts are less than long-term groundwater abstraction rates. The ‘real world’ hydrogeological mechanisms behind these impact patterns are discussed. The paper also recommends a protocol for using regional models to assess individual licensed groundwater abstraction impacts across the full range of historic climate conditions (typically, as monitored since 1970) and in the context of other operational artificial influences.