Show of the year - Getting On. The third run of writer-star trio Jo Brand, Joanna Scanlan and Vicki Pepperdine's BBC4 series set in an NHS hospital was quite simply the best piece of British small-screen fiction in years. Branching out even further from its notional sitcom roots, it administered shots of high farce, occupational satire, metaphysical meditation and excruciating realism. I refuse to accept that Pepperdine's Dr Pippa Moore is not, at this moment, wafting through some overstretched ward, offering supercilious side smiles to confused geriatrics.

The definition of a slow-burn hit, this diffident black comedy picked up another armful of admirers with its third series - at this rate it'll sweep the 2017 Baftas. Life on the geriatric NHS ward staffed by nurses Den (Joanna Scanlan) and Kim (Jo Brand) and plagued by sniffy consultant Pippa (Vicki Pepperdine) was much the same. It was slightly worsened by increased outsourcing and management-speak but was still a case of making do, looking for small victories and, in the moments that give the series its tender heart, remembering that easing patients' pain is the point. Scanlan, Brand and Pepperdine's acting and writing was more assured then ever, with nicely woven story arcs never taking away the best thing about the series: it lets its realistic, ragged characters breathe.

Quietly brilliant and deserving of a lot more noise, Jo Brand, Joanna Scanlan and Vicki Pepperdine's hospital comedy has explored the intersection between what's funny and what's heartbreaking without any self-regard or fuss.

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Radio Times review

A obvious triumph for BBC4's understated cleverness, increasingly celebrated as the superb third series developed, was Getting On, which ended its run on Wednesday. Jo Brand, Joanna Scanlan and Vicki Pepperdine write and act this comedy, set in a women-only geriatric hospital ward. It's a masterclass in letting your creations breathe.

The main characters are all female, something that hardly ever happens on television but is never emphasised. This series acknowledged the accelerating privatisation of the health service, but wove it into Pepperdine's ace portrayal of the antagonist Dr Moore, a brittle snob who uses her sharp elbows to nurse her own reputation and sees patients as stock to be processed - or, in series three, potential subjects for her photographic study of vaginal atrophy in the elderly.

Dr Moore's desire for profitable efficiency is constantly undermined by grubby reality in the form of Den and Kim, the ward sister and nurse who have to dish out the drugs, shuffle the beds and "wipe the bums". Scanlan's Den is a jumble of kindness, daydreams, delusion and loneliness whose pregnancy this year made her even more distracted and vulnerable - but Kim is our eyes and heart, thanks to Brand's selfless performance.

Getting On gives Kim no comic traits apart from weary bluntness and a drab home life, hinted at in phone calls about running out of fish fingers and ketchup. While the funny, absurd stuff was happening to Pepperdine and Scanlan, Brand represented the show's frustrated compassion, buffeted by bureaucratic idiocy and often disobeying orders to do little favours for the patients or avoid another dirty, pointless task.

Kim's attempt to become a doctor was crushed in mundane fashion: she didn't have the time or ability to pass the relevant course. The last episode had emotional pay-offs for Dr Moore and Den, earnt through careful but unobtrusive series-long plotting, that gave the characters new depth. Kim just bumbled off home as usual but, BBC4 budgets willing, she'll be back to win more tiny victories against depressing odds.

Honest, warm and human, Getting On's wry dramatisation of the inefficiences of the NHS is as clever as it is funny; the script is a credit to Jo Brand, Joanna Scanlan and Vicki Pepperdine. In the series finale, a group of schoolchildren arrives at the geriatric ward to sketch images of the patients and Sister Den (Scanlan) is sceptical: "Most are doolally, deaf or asleep. Good luck to them." Watch for cameo appearances by Hugh Bonneville and Tilda Swinton.

Getting On doesn't heave with belly laughs, it's more about smiling in pained recognition at the small things about life and death and the NHS. But there's a proper gut-buster of a gag on K2 ward tonight involving a Christmas card competition among hospital staff for the kids' oncology ward and an unfortunate guinea pig on the terrible Dr Moore's icky pet project.

Moore (Vicki Pepperdine) is at her tin-eared worst when she tries to save her skin and later when she has to break some bad news. The woman is barely on nodding acquaintance with compassion and, as usual, she has to leave the tenderness to others. Well, I say "tenderness", but in the case of wily Sister Den (Joanna Scanlan) it's more a case of revising history.

Getting On (Wednesday, BBC Four), an understated comedy set in a drab NHS ward is luckily still going. It is telling that there is a Thick of It connection, with Peter Capaldi directing early episodes. It stars, and is written by, Jo Brand, Vicki Pepperdine and Joanna Scanlan (another stalwart from The Thick of It).

I love the washed-out almost monochrome palette, the wobbly camera work, the avoidance of a laughter track, the naturalistic dialogue.

In the latest episode earnest, politically correct former Matron turned Business Consultant Hilary Loftus (Ricky Grover) was on fine form making sure all electrical appliances were turned off as part of a new green initiative. If you have had any experience of the NHS you will appreciate that this is depressingly well observed.

Getting On is a minor masterpiece of a hospital comedy that truly deserves a wider audience.

This week, the staff were grappling with a green initiative cascading down from on high but it was Sister Den's story that caused cardiac arrest as she struggled with her pregnancy.

Joanna Scanlan, who also plays the 'blockage' known as Terri in Armando Iannucci's top-drawer political satire The Thick Of It, is an unsung heroine of British comedy.

Nurse Kim and Sister Den (Jo Brand and Joanna Scanlan) attend a grim hospital meeting led by the perky Damaris designed to "cascade down" the hospital's energy-saving initiative.

Its leading exponent is lugubrious Mr Loftus, who makes it his business to empty rubbish into the correct bags and check that Ward K2 isn't wasting power now it has a meter. "We will be recording in ohms and wattage," he announces, pointlessly.

Thus Getting On gives us another perfectly bleak vignette, poking a stick at the rattling absurdities of health service bureaucracy. It doesn't shout messages, it's about the small things, and it's full of heart and humanity.