Dr. Patrick Spiller became Holby A&E's SPR during series 14. We first saw him driving his car dangerously on the way to work. When he arrived his abrupt and rude manner immediately put everyone's back up. Although he was a brilliant doctor he cared only about the clinical side of things and seemed to have no respect for the other staff.
It soon became apparent that he and Holly had met before. They had had a relationship when Patrick was an SHO and Holly was a student; in the end Holly had dumped him. Patrick tried to ask Holly out again, but she turned him down. On Valentine's Day Holly called him emotionally dysfunctional when he said the occasion was just an excuse for shopkeepers to get rid of a load of old tat. After an argument with Holly over the treatment of a girl, and his refusal to go to Frank Gallagher's funeral, Patrick bought her a bunch of red roses. Holly was angry, asking if he thought this made up for his behaviour today. Patrick said he liked to maintain a sense of professional detachment from his patients; Holly told him to remain professionally detached from her.
When Patrick realised that Adam Osman was gay, he seemed to insult him even more, and told him to be careful as patients might not like it if they knew he was homosexual. When he found out that Adam was HIV positive, Patrick's attitude towards him was even worse. He said that he had nothing against Adam being gay, but because he has HIV it means he can't do the job properly in resusc, which is what counts, and there are plenty of nurses out there who can.
We saw a slight softening of Patrick's attitude when he decided not to tell anyone about Barney Wolfe not bringing in his mate Ewen into A&E when he was stabbed. Barney could have lost his job if anyone found out, but Patrick said they'd keep it between themselves. We also saw Patrick taking home a dog whose owner had been admitted to the hospital.
When Holly got involved with a family where the mother seemed to be neglecting her children, she turned to Patrick for advice. When things got to their worst and the mother was taken away from her children, Patrick comforted Holly. She was feeling guilty; he hugged her and told her she was the best SHO in the room. (She was the only SHO in the room.) Patrick told her not to beat herself up over this, saying that there are a lot more serious things wrong with her that she needs to sort out. Holly said, "I really do hate you, you know," and let him hug her again. Patrick replied, "I know, and it means a lot to me."
In the last episodes of the series, Patrick was treating a patient who was dying of AIDS. The patient didn't want to see his mother before he died, but Patrick kept trying to persuade him that it would be for the best if he did. Eventually the patient asked him to fetch his mother. As she arrived, just in time, Patrick was relieved. Adam commented about him almost showing some warmth; Patrick told him that he never had chance to say goodbye to his mum - she died when he was ten and didn't want him to see her when she was ill. He said she had her dignity, and that he knows she loved him. He apologised to Adam for the things he'd said, telling Adam never to stop doing the work he can do, saying he's too good, before adding, "You big pouf!"
At the beginning of series 15 Patrick showed his kinder side again by offering Spencer a bed for a few nights after discovering that Spencer had been thrown out of his bedsitter. But his cutting remarks to the rest of the staff continued to the point where they made a list of his insults and asked him to pay a fine for each of them.
At Christmas, Patrick and Holly got stranded in the snow on their way back from the Paediatric department's Christmas lunch. They spent their time squabbling, and Holly asked Patrick why he hated Christmas so much. He told her that his mum died on Christmas day, when he was ten, and that Christmas is thrust down their throats from October and all he can think about is his mum. Patrick made a move to kiss Holly, but she dodged it.
Later in the series Patrick started seeing a nurse, Carol. He and Holly almost got closer again when, on moving into a new house, Holly thought Patrick had sent her some champagne, but Patrick managed to insult her again and she told him to go back to Carol. When Holly started to receive more anonymous gifts, Patrick was the first person to come under suspicion, but it became clear that he was not the one sending them. As the situation became worse and Holly realised she had a stalker, Patrick tried to be there for her as a friend. He wasn't too happy when the crisis came and Dan Robinson, who had been vying with Patrick for Holly's attention, was the one to act the hero and save Holly from her stalker Tom Harvey. Afterwards he didn't handle the situation very well and managed to offend Holly yet again. He apologised, telling Holly that he got so angry about the stalker, because it was Holly who was being hurt, but Holly didn't react.
At the end of the series Ed, an old colleague of Patrick and Holly's, turned up in the department. It turned out that Holly had left Ed for Patrick. Ed, a medical student at the time, had been thrown off the course for taking drugs and Holly had always believed that Patrick had been behind this, but Patrick now told her that it hadn't been down to him. He said she was always trying to change him, and he'd never be good enough for her, but Holly told him he was good enough, and they agreed to go for a drink after the shift. However, that afternoon Holly went missing, and after a visit to Ed, who denied seeing her, Patrick realised that Tom must have been let out of prison. With Max and Dan, Patrick started searching for Holly, and was there when Holly, having been tied up by Tom, managed to free herself long enough to smash a window and call for help. Eventually Patrick got to her, but by this time Tom had injected her with anaesthetic. Patrick started mouth-to-mouth, and Holly came round and clung to him.
By the beginning of series 16, however, Holly had left Holby and was travelling round Germany, and Patrick was seeing police sergeant Rachel James. Rachel was married, though her husband worked away from home. But seeing Rachel didn't stop Patrick from making advances to new SHO Lara Stone, all of which were firmly turned down. After passing the exam qualifying him to become a consultant, Patrick started applying for posts. When he was turned down for the first post he applied for, he blamed Max's reference, and took his revenge the first chance he had, by reporting Max to Chief Executive Jan Goddard when he discovered Max had been supplying methadone to his near-stepson Ben.
When Rachel started talking about leaving her husband Greg for Patrick, Patrick wasn't sure he was that serious about her. But he realised his true feelings when the same day, Rachel was brought into A&E after being attacked by some muggers she was chasing. And both he and her husband Greg were shocked to discover she was pregnant - Greg realised she must have been seeing someone else. Rachel, seriously injured, died, and Greg watched as Patrick was said goodbye to her, telling her he loved her. Greg later attacked Patrick, leaving him seriously injured, but he was eventually found, and Lara was at his bedside when he finally came round. He and Lara grew closer after his recovery, and eventually became an item. But when Patrick got a consultant's post in London, they were uncertain of what to do. Patrick proposed to Lara, but she wouldn't accept, not wanting to follow him to London. The evening after Patrick nearly died in an RTA, however, they went for a meal and both were prepared to make compromises so they could be together. This time, when Patrick proposed, Lara accepted. But soon afterwards, Patrick collapsed with an unseen head injury from the RTA, and despite the A&E team's best efforts, he died.