Increasing numbers of regional climate change scenario assessments have become available for the North Sea. A critical review of the regional studies has helped identify robust changes, challenges, uncertainties and specific recommendations for future research. Coherent findings from the climate change impact studies reviewed in this chapter include overall increases in sea level and ocean temperature, a freshening of the North Sea, an increase in ocean acidification and a decrease in primary production. However, findings from multi-model ensembles show the amplitude and spatial pattern of the projected changes in sea level, temperature, salinity and primary production are not consistent among the various regional projections and remain uncertain. Different approaches are used to downscale global climate change impacts, each with advantages and disadvantages. Regardless of the downscaling method employed, the regional studies are ultimately affected by the forcing global climate models. Projecting regional climate change impacts on biogeochemistry and primary production is currently limited by a lack of consistent downscaling approaches for marine and terrestrial impacts. Substantial natural variability in the North Sea region from annual to multi-decadal time scales is a particular challenge for projecting regional climate change impacts. Natural variability dominates long-term trends in wind fields and strongly wind-influenced characteristics like local sea level, storm C. Schrum