Ultrasound screening for fetal abnormalities has been available to pregnant women in England for well over two decades. Historically, clinical departments have used guidance provided by the Royal College of Obstetricians and Gynaecologists to inform them as to what should be included for assessment during the examination. Recently, the Department of Health commissioned the Fetal Anomaly Screening Programme to develop and extend the second trimester anomaly scan to ensure an effective and accessible service for all pregnant women in England. The Fetal Anomaly Scan National Standards have now been launched and will impact on all departments providing this service. This paper summarizes the background to this work, identifies the subtle shift of focus required in the new anomaly scan and explains the rationale behind these changes.