If you are trying to reply to a patient request and are only able to add an 'internal note', there are a couple of possible reasons for this:
The patient does not have access to an online account
If the patient does not have an online account for askmyGP (no email address on record), you will not be presented the option to reply to their request via messaging. A member of the reception team will have taken the patient's request over the phone, or face-to-face on the front desk and these requests will need to be managed via the telephone.
The practice have pre-registered the patient for their online askmyGP account, but the patient has not yet logged in
Ideally, patients with online access should be registering themselves and submitting their own requests online. However, if the receptionist did this for them, they will first need to register the patient with their email address, then select the option to 'send the welcome email'. This will generate an email link to the patient for them to create the password for their account. Once the patient does this and logs in for the first time the receptionist will then have the option to respond via messaging.*
*The system will not permit you the option to message the patient until they have logged into their online account first, this is to ensure that the correct email address and patient details have been recorded and to confirm that the patient is able to successfully access their online account and any messages that you send to them when managing their request.