This episode was a deeply affecting conclusion to a very transitional series for this show. Series 6 of this show took some heat from longtime fans as being too much of a departure from the story as it had been established over the previous five series. You can read such comments in the reviews linked to the main IMDb page for this show.
It's a dilemma many shows in the U-S face in their later seasons. Do we introduce change for the beloved characters, such as normal people would encounter in their lives, or do we double down our bets on fan expectations and lavish on them more of the things they already love and depend on in the show? Most shows choose to cater to the fan base, to their detriment as plots become more boring and improbable. Some shows choose to embrace change in order to keep their original premise intact, and this is how I prefer to view Series 6 of Doc Martin.
I missed a few of the episodes, but I was glad to see something new in the lives of these characters, changes in their outlooks and attitudes, changes in their situation, such as people encounter. I loved the stories I saw, and I was so unprepared for the final moments of this episode. This season finale was filled with unrest and anger, and decisions and new directions. Changing the most: Dr Ellingham, resolving issues with his mother, building new closeness with his Aunt Ruth, and by the end of this episode, fully knowing the content of his own yearning heart for once.
I have hopes for the next series of this show. I'm glad it's in a place where I can't possibly anticipate what's going to happen. Martin and Louisa are the closest they have ever been to finally getting over themselves and getting it right, and that's exciting.